Can pulmonary aspiration of gastric contents be prevented by balloon occlusion of the cardia? A study with a new nasogastric tube.
Rapid-sequence induction of anesthesia and the application of cricoid pressure are the two most common maneuvers performed when patients requiring general anesthesia are at risk of pulmonary aspiration. However, these procedures are quite elaborate and entail risks and dangers in themselves. A new disposable nasogastric balloon tube was developed to prevent the reflux of gastric contents by blocking the cardia with a balloon. The effectiveness of this tube was investigated in animals and healthy volunteers. In addition, we describe the initial experience with the tube during ventilation via a mask in patients with an increased risk of aspiration. Twelve pigs with a blocked cardia did not show any gastroesophageal reflux under six different procedures to provoke vomiting and regurgitation (gastric fluid filling with different volumes, head-down positioning, drug-induced vomiting, external gastric compression before and after surgical ligation of the pyloric orifice), whereas 37 of 48 provocation maneuvers led to a reflux in eight additional pigs with an unblocked cardia. In 26 test subjects with a blocked cardia, reflux of gastric contents was not observed when vomiting was provoked. After elimination of the cardia blockade, a reflux could be triggered in 24 of the 26 subjects. Among 42 patients in danger of aspiration, anesthesia could be induced without any problems using a nasogastric balloon tube with ventilation via a mask. The present experimental findings in animals and test subjects show that the nasogastric balloon tube can prevent gastroesophageal reflux under provocation of vomiting and regurgitation.(ABSTRACT TRUNCATED AT 250 WORDS)
Roewer
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Department of Anesthesiology, University Hospital Eppendorf, Hamburg, Germany.
D000328:Adult; D000818:Animals; D002404:Catheterization / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation*; D008297:Male; D011015:Pneumonia, Aspiration / Q000517:prevention & control*; D013552:Swine