Title: Anaesthesia and gastric content — new methods and new trends
Abstract: Abstract: In the present investigation, factors that might influence gastric content and the risk of perioperative aspiration pneumonitis have been studied. Compared to fibre‐optic gastroscopy and electronic pH meter, a standardised blind orogastric aspiration and pH indicator paper technique was found to be simpler, less expensive and to produce gastric fluid volume and pH estimates with sufficient accuracy. In fasting, elective patients, neither benzodiazepine premedication nor level of anxiety influenced gastric fluid volume and acidity. Intramuscular morphine‐scopolamine premedication significantly reduced gastric acidity. No difference in gastric content could be detected between outpatients and inpatients or between patients taking an oral benzodiazepine premedication 1–2 h before anaesthesia with 20, 150 or 300–450 ml of water. Intake of 150 ml water was associated with the lowest anxiety scores. In a meta‐analysis of 12 randomised studies of the impact of oral fluid intake on gastric content, statistical and technical flaws rendered the conclusion of two studies invalid. This, however, did not change the main conclusion that intake of clear fluids up to 2 h preoperatively is safe as fluid intake either decreased or had no effect on gastric fluid volume. Use of sugarless gum was associated with a 50% increase in gastric fluid volume, but did not affect gastric fluid acidity or improve patients' well‐being. In smokers, nicotine gum improved the feeling of well‐being and did not increase gastric fluid volume or acidity. Using gastric ultrasonography in healthy female volunteers, it was shown that up to 4 hours is needed before a light breakfast meal is completely emptied. In order to provide some safety limits, a 6‐hour fasting period for solids was recommended. In a survey of Norwegian Departments of Anaesthesiology (100% response rate), the respondents showed considerable variation in use and attitudes towards preoperative fasting and aspiration pneumonitis prophylaxis in OB/GYN patients. In an audit of perioperative aspiration pneumonitis we identified 11 cases, giving an incidence of 1, 5 and 11 per 10000 anaesthesia in gynaecological in‐ and outpatients and caesarean section patients, respectively. Preventable factors were identified in all cases. Eight patients needed ICU treatment, but none died. At discharge all had symptoms of bronchial hyper‐reactivity, but during the follow‐up period they all experienced improvement in their condition. There appears to be a need for consensus discussions on the topic of preoperative fasting and aspiration pneumonitis prophylaxis.
Publication Year: 1996
Publication Date: 1996-11-01
Language: en
Type: article
Indexed In: ['crossref']
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