Does an Indwelling Gastric Tube Facilitate Regurgitation During Anaesthesia?

Tryba, M.; Zenz, M.; Mlasowsky, B; Huchzermeyer, H.; Modell, Jerome H.

doi:10.1097/00132586-198406000-00054

Cited by 8 publications

(9 citation statements)

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“…For passive regurgitation and pulmonary aspiration to occur during anaesthesia, a certain gastric volume must be present; a minimum of 200 ml is probably a fair estimate25–27. This contrasts with the gastric volumes generally found in otherwise healthy elective patients.…”

Section: Pulmonary Aspiration and Preoperative Fasting: Fact And Fictionmentioning

confidence: 94%

Preoperative fasting

Ljungqvist

Søreide

2003

British Journal of Surgery

306

164

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Section: Pulmonary Aspiration and Preoperative Fasting: Fact And Fictionmentioning

confidence: 94%

Preoperative fasting

Ljungqvist

Søreide

2003

British Journal of Surgery

306

164

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“…For passive regurgitation and pulmonary aspiration to occur during anaesthesia, a certain gastric volume needs to be present. Studies (41) indicate that more than 200 ml is needed in an adult patient. In otherwise healthy elective patients much lower gastric fluid volumes in the range of 10-30 ml are found (9)(10)(11)42).…”

Section: Gastric Content and Gastro-oesophageal Refluxmentioning

confidence: 99%

Pre‐operative fasting guidelines: an update

Søreide

Eriksson

Hirlekar

et al. 2005

Acta Anaesthesiol Scand

230

106

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Liberal pre-operative fasting routines have been implemented in most countries. In general, clear fluids are allowed up to 2 h before anaesthesia, and light meals up to 6 h. The same recommendations apply for children and pregnant women not in labour. In children <6 months, most recommendations now allow breast-or formula milk feeding up to 4 h before anaesthesia. Recently, the concept of pre-operative oral nutrition using a special carbohydrate-rich beverage has also gained support and been shown not to increase gastric fluid volume or acidity. Based on the available literature, our Task Force has produced new consensus-based Scandinavian guidelines for pre-operative fasting. What is still not clear is to what extent the new liberal fasting routines should apply to patients with functional dyspepsia or systematic diseases such as diabetes mellitus. Other still controversial areas include the need for and effect of fasting in emergency patients, women in labour and in association with procedures done under 'deep sedation'. We think more research on the effect of various fasting regimes in subpopulations of patients is needed before we can move one step further towards completely evidence-based pre-operative fasting guidelines. Accepted for publication 16 March 2005Key words: Anaesthesia; general; gastric content; gastric emptying; preoperative fasting; pulmonary aspiration complications. # Acta Anaesthesiologica Scandinavica 49 (2005)A NAESTHESIA-RELATED pulmonary aspiration leading to respiratory failure (Aspiration Pneumonitis; Mendelson's syndrome) has been described in both elective and emergency surgical patients (1-7). With the hope of reducing the risk of this complication, rigid fasting routines before surgery have been enforced (8). However, the scientific basis for these rigid fasting routines in elective patients has been challenged and found to be nonexistent (9-11). Based on this new information, several national anaesthesia societies now have accepted more liberal fasting rules for clear fluids (water, clear juices, coffee, tea) (12-17). Intake of solids in the morning of elective surgery is still not recommended.To what extent pre-operative fasting is of any importance in emergency cases is still a matter of uncertainty with variation in clinical practice. Further, it is also not clear to what extent specific patient populations with suspected or proven delayed gastric emptying need to be exempt from the new fasting guidelines (16,17). Recently, a new method for pre-operative optimization of the elective patient, oral nutrition with carbohydrates (16,18,19), has been introduced, but so far has not been widely implemented into clinical practice.This review aims to give an update on preoperative fasting and gastric content as a risk factor of pulmonary aspiration. We will focus on the development and experience with the new and more liberal clinical practice guidelines, but also present still controversial areas worth further research. Anaesthesia-related pulmonary aspiration: risk factors Gastric e...

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“…Most authors (23,25,28) agree that liberal use of pre-induction mechanical gastric emptying is no longer indicated, but instead should be used after induction and intubation. Using a gastric tube in an unintubated, anaesthetised patient, as in one of our cases, increases the risk of pulmonary aspiration (29) and must be considered substandard anaesthesia care.…”

Section: Discussionmentioning

confidence: 81%

An audit of perioperative aspiration pneumonitis in gynaecological and obstetric patients

Søreide¹,

Bjørnestad

Steen

1996

Acta Anaesthesiol Scand

108

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Obstetric patients are considered to be at increased risk of anaesthesia-related Aspiration Pneumonitis. Less is known about the incidence and morbidity of this complication in younger women undergoing gynaecological surgery. We performed a 4-year audit of perioperative Aspiration Pneumonitis, defined as bronchospasm, hypoxia, cough and dyspnea, together with radiographic or auscultatory abnormalities, following a witnessed episode of gastric content entering the trachea or an intraoperative episode making pulmonary aspiration likely, in two larger Norwegian hospitals. Eleven cases were identified; 4 in Caesarean Section (C-section) patients, 5 in gynaecological (GYN) outpatients and 2 in GYN inpatients, with incidences of 0.11%, 0.04% and 0.01% respectively (P = 0.03). Risk factors were present in all patients. No patient died, but the short-time morbidity in the form of prolonged ICU stay and hospitalisation was significant. At discharge all patients noted symptoms of dyspnea, cough, and tightness of the chest; symptoms explainable by bronchial hyperreactivity. Five patients felt these symptoms did not disappear within 3 months and were followed up for a median of 2 years (range 4 months to 4 years). All were smokers and had multiple confounding causes, which made it hard to link their prolonged complaints directly to the pulmonary aspiration incident. All experienced improvement of symptoms during the follow-up period. Compared to gynaecological patients of similar age, C-section patients still have an increased risk of suffering Aspiration Pneumonitis. Prevention can be further improved in both groups. A cause-relationship between the incidence and respiratory complaints lasting longer than 3 months could not be established, and a structured follow-up may be helpful to avoid later medicolegal claims.

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Does an Indwelling Gastric Tube Facilitate Regurgitation During Anaesthesia?

Cited by 8 publications

References 0 publications

Preoperative fasting

Preoperative fasting

Pre‐operative fasting guidelines: an update

An audit of perioperative aspiration pneumonitis in gynaecological and obstetric patients

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