Gastro-oesophageal reflux and regurgitation during general anaesthesia for termination of pregnancy.
Gastro-oesophageal reflux (GOR) and regurgitation were investigated with an oesophageal pH electrode, inserted after the induction of general anaesthesia with methohexitone, in 100 patients undergoing termination of pregnancy, 50 in the first trimester and 50 in the second. GOR occurred in 17 patients, 8 in the first trimester and 9 in the second trimester. On withdrawal of the pH electrode into the pharynx it was found that only 2 of these patients had regurgitated, 1 from each trimester. Regurgitation was not clinically detectable and there was no pulmonary aspiration. Twenty three patients had hiccup of whom 10 refluxed, 9 of them immediately after starting to hiccup. Those patients with hiccup were more likely to reflux than the remainder (P<0.001). Patients with preoperative symptoms of GOR had no greater incidence of reflux during anaesthesia than those without symptoms. The function of the upper oesophageal sphincter appears to be preserved in the majority of these patients with the general anaesthetic technique used. This work therefore suggests that the need for rapid sequence induction is no greater in the second trimester than the first.
Vanner
R G
RG
Department of Anaesthetics, St Thomas' Hospital, Lambeth Palace Road, London SE1 7EH, UK.