[Comparison of gastric aspirate volume after intubation in patients with and without symptoms of gastroesophageal reflux disease].
OBJECTIVE
To compare the postintubation gastric aspirate volume of patients with and without symptoms of gastroesophageal reflux disease (GERD).


METHODS
Prospective randomized study of 331 physical status ASA I-II adults scheduled for surgery. Patients with GERD symptoms (heartburn and regurgitation) were assigned to group A (n=83); asymptomatic patients (n=248) were assigned to groups B (n=85), C (n=70), and D (n=93). Group A was subdivided: group A1 received outpatients treatment for GERD and group A2 did not. Groups A, B, and C received prophylaxis with omeprazole 40 mg and metoclopramide 10 mg, respectively. Group D received no prophylaxis. Groups A and B patients received 1 mg x kg(-1) of succinylcholine, and groups C and D received 0.2 mg x kg(-1) of cisatracurium. After intubation, gastric content was aspirated and measured. The results were compared with Pearson's chi2 and Student t tests, analysis of variance, and Kruskal-Wallis and Mann-Whitney U tests.


RESULTS
The gastric aspirate volumes in each group were as follows: 36.6 (SD 5) mL in group A; 9.98 (4.9) mL in group B; 10.8 (5.5) mL in group C; 15.62 (6.3) mL in group D; 32.7 (5.1) mL in group A1; and 39.08 (3.6) mL in group A2. Volumes were significantly greater in group A than in groups B, C, and D (P<0.0001), and in subgroup A2 than in subgroup A1 (P<0.001). The percentages of patients from whom a volume greater than 25 mL was aspirated in each group were as follows: 98.9% of group A, 1.2% of group B, 2.8% of group C, and 8.6% of group D (P<0.001).


CONCLUSIONS
Patients with chronic heartburn and regurgitation have greater postintubation gastric aspirate volumes than do asymptomatic patients, attributable to the gastroesophageal motility dysfunction characteristic of GERD that can favor aspiration. GERD questions should be included in preanesthetic medical history taking, and symptomatic patients should be prescribed outpatient proton pump inhibitor therapy.
Cassinello Ogea
C
C
Médico Adjunto al Servicio de Anestesiología y Reanimación. ccassinello@salud.aragob.es
Oliva Perales
P
P
Herranz Andrés
P
P
Izquierdo Villarroya
B
B
Val Pérez
J
J
Beisty Abengochea
J M
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D001279:Atracurium / Q000031:analogs & derivatives; D015154:Esophageal Motility Disorders / Q000150:complications / Q000503:physiopathology; D005260:Female; D005283:Fentanyl; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000503:physiopathology*; D005766:Gastrointestinal Contents; D005769:Gastrointestinal Motility; D006356:Heartburn / Q000209:etiology; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D007441:Intubation, Gastrointestinal; D007442:Intubation, Intratracheal; D008297:Male; D008738:Methyl Ethers; D008787:Metoclopramide / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged; D009853:Omeprazole / Q000008:administration & dosage / Q000627:therapeutic use; D011015:Pneumonia, Aspiration / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care; D011446:Prospective Studies; D000077149:Sevoflurane; D013390:Succinylcholine; D013396:Suction
D008738:Methyl Ethers; D001279:Atracurium; D000077149:Sevoflurane; D013390:Succinylcholine; D009853:Omeprazole; D008787:Metoclopramide; C101584:cisatracurium; D005283:Fentanyl