Continuous Hypopharyngeal pH Measurements in Spontaneously Breathing Anesthetized Outpatients

Joshi, G. P.; Morrison, Stuart; Okonkwo, N. A.; White, Paul F.

doi:10.1213/00000539-199602000-00007

Cited by 5 publications

(7 citation statements)

References 15 publications

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“…In a large survey of LMA usage, it has been shown to be both safe and effective in a wide variety of surgical conditions [1]. However, it remains controversial as to whether the LMA predisposes patients to gastro‐oesophageal reflux [5–7, 9, 11, 14–16].…”

Section: Discussionmentioning

confidence: 99%

Gastro‐oesophageal reflux during day case gynaecological laparoscopy under positive pressure ventilation: laryngeal mask vs. tracheal intubation

Skinner

Mahajan

1998

Anaesthesia

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SummaryWe compared the postoperative effects, in particular nausea and vomiting, of two commonly used anaesthetic agents, isoflurane and desflurane, in patients undergoing day-case arthroscopic surgery. We found a significantly higher incidence of postoperative nausea and vomiting in those patients receiving desflurane. In our study, desflurane was associated with a higher incidence of peroperative respiratory complications, including airway irritability and coughing. Accepted: 20 February 1998 Postoperative nausea and vomiting (PONV) is a major side-effect of general anaesthesia [1]. If PONV occurs in patients undergoing day-case surgery, it may result in delayed discharge, or even overnight admission. Hence an anaesthetic agent with a good recovery profile is particularly advantageous for day-case surgery. Desflurane, a relatively new fast-acting agent, is an attractive agent for day-case surgery [2][3][4]. Theoretically, its low blood/gas solubility should ensure rapid offset. However, its emetogenic potential has not been thoroughly investigated. In our study, we compared the effects of this drug with isoflurane, an agent which has been widely used in a day-case environment [5]. MethodsWith the approval of the local ethics committee and after written informed consent had been obtained, we studied 156 ASA physical status 1 and 2 unpremedicated patients who were scheduled for day-case arthroscopic knee surgery. Patients studied were between the ages of 16 and 70 years. Pre-operatively, details of medical history, including PONV, smoking and current medications, were noted. The patients' weights and blood pressures were recorded.Patients with previous adverse reactions to any of the proposed anaesthetic agents were not studied.In the anaesthetic room, the patient was monitored with noninvasive blood pressure and pulse oximetry. Intravenous access was established and propofol (3-4 mg.kg À1 ) was used to induce anaesthesia. This was supplemented with a single bolus of fentanyl (1-1.5 g.kg À1 ). Ventilation was gently supported with 100% oxygen until diminished muscle tone allowed insertion of a laryngeal mask airway (LMA). The LMA was secured and a capnograph was attached. Patients were randomly allocated to receive either isoflurane or desflurane in a mixture of 33% oxygen in nitrous oxide. Manual ventilation was discontinued when spontaneous respiration recommenced.In the operating theatre, the electrocardiogram, oxygen saturation and end-tidal carbon dioxide were assessed continuously. Noninvasive blood pressure was measured every 3 min. The selected volatile agent was administered at a concentration approximating to twice MAC for a period of 3 min. After this time, the inspired vapour concentration was adjusted according to clinical assessment of the patient's requirements; 4-7% for desflurane and 1-2.5% for isoflurane, previous studies having demonstrated these to balance appropriate anaesthetic Anaesthesia, 1998 910ᮊ 1998 Blackwell Science Ltd depth with cardiovascular and respiratory stability. Any ca...

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Section: Discussionmentioning

confidence: 99%

Gastro‐oesophageal reflux during day case gynaecological laparoscopy under positive pressure ventilation: laryngeal mask vs. tracheal intubation

Skinner

Mahajan

1998

Anaesthesia

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“…The lower and upper oesophageal sphincter tone varies with the level of consciousness and the anaesthetic technique. Inadequate depth of anaesthesia, hiccoughing, straining or coughing may increase gastro‐oesophageal reflux (5). We standardized the anaesthetic technique and the surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

“…The LOS tone and the upper oesophageal sphincter tone decrease with the increasing depth of anaesthesia. The upper oesophageal sphincter tone decreases with neuromuscular blockade, but it is preserved in spontaneously breathing patients (5). Although we used neuromuscular blockade and controlled ventilation, none of our patients suffered clinical reflux or adverse airway events such as laryngospasm.…”

Section: Discussionmentioning

confidence: 99%

“…A limiting factor for the use of the LMA is the lack of airway protection from regurgitated gastric contents (1,2). There are conflicting results with the reported incidence of gastro‐oesophageal reflux and regurgitation during anaesthesia with the LMA (3–8). It has recently been reported that the use of the LMA increases the incidence of gastro‐oesophageal reflux compared to FM and TT, because of gastric dilatation and a decrease in lower oesophageal sphincter tone (4,9–11).…”

Section: Introductionmentioning

confidence: 99%

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Distal oesophageal pH measurement in children during general anaesthesia using the laryngeal mask airway^TM, tracheal tube and face mask

Özlü

Türker

Özgün³

et al. 2001

Pediatric Anesthesia

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“…Therefore, the effects of neuro‐ muscular relaxants and intermittent positive pressure on the competence of the gastroesophageal barrier could be excluded. In a subsequent attempt to verify the importance of this finding, Joshi et al (16) inserted, also in adult patients, pH probes at the hypo‐ pharyngeal level, since they postulated that the clinical significance of the gastric regurgitation was stronger at the hypopharyngeal level than in any other section of the oesophagus, but did not detect any episodes of reflux at this level. We could not tell if any of the episodes of GOR reached a higher level of the oesophagus, but the technical difficulty of fixing a probe at this level, and the patient's discomfort, made us use the mid oesophagus.…”

Section: Discussionmentioning

confidence: 99%

Continuous monitoring of oesophageal pH during general anaesthesia with laryngeal mask airway in children

Cebrían

Avellanal

Morales³

2000

Pediatric Anesthesia

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We studied the incidence of gastro-oesophageal reflux (GOR) during general anaesthesia with the laryngeal mask airway (LMA) in a paediatric population with two ventilatory regimes: spontaneous breathing and controlled mechanical ventilation (CMV). Thirty children between 6 months and 15 years, ASA I-II, for routine surgery, were randomly assigned in two groups: spontaneous ventilation (n=14), and CMV (n=16). A pH probe was situated in the central third of the oesophagus. Some 66% of the patients breathing spontaneously had GOR episodes vs. 92% of the patients with CMV (P < 0,01). Reflux took place mainly after LMA removal (21% vs. 68%; P < 0,01) and in the Postanaesthetic Care Unit (PACU) (29% vs. 43%; P < 0,05). There was a high incidence of GOR during general anaesthesia and in the PACU in paediatric patients anaesthetized with the LMA. GOR episodes were significantly more evident in the CMV group, mainly after LMA removal, but without clinical significance.

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Continuous Hypopharyngeal pH Measurements in Spontaneously Breathing Anesthetized Outpatients

Cited by 5 publications

References 15 publications

Gastro‐oesophageal reflux during day case gynaecological laparoscopy under positive pressure ventilation: laryngeal mask vs. tracheal intubation

Gastro‐oesophageal reflux during day case gynaecological laparoscopy under positive pressure ventilation: laryngeal mask vs. tracheal intubation

Distal oesophageal pH measurement in children during general anaesthesia using the laryngeal mask airway^TM, tracheal tube and face mask

Continuous monitoring of oesophageal pH during general anaesthesia with laryngeal mask airway in children

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Continuous Hypopharyngeal pH Measurements in Spontaneously Breathing Anesthetized Outpatients

Cited by 5 publications

References 15 publications

Gastro‐oesophageal reflux during day case gynaecological laparoscopy under positive pressure ventilation: laryngeal mask vs. tracheal intubation

Gastro‐oesophageal reflux during day case gynaecological laparoscopy under positive pressure ventilation: laryngeal mask vs. tracheal intubation

Distal oesophageal pH measurement in children during general anaesthesia using the laryngeal mask airwayTM, tracheal tube and face mask

Continuous monitoring of oesophageal pH during general anaesthesia with laryngeal mask airway in children

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Distal oesophageal pH measurement in children during general anaesthesia using the laryngeal mask airway^TM, tracheal tube and face mask