Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The author presents a four-year-old boy with Pelizaeus-Merzbacher disease who required anaesthesia during placement of PE (pressure equalization) tubes and a permanent silastic intravascular device (Broviac catheter). Pelizaeus-Merzbacher is one of a group of progressive, degenerative disorders of the cerebral white matter known as the leukodystrophies. They include metachromatic leukodystrophy, adrenoleukodystrophy, Krabbe's disease, Canavan's disease, Alexander's disease and Pelizaeus-Merzbacher disease. Due to the progressive nature of the disorders and their devastating effects on the central nervous system, these children frequently require anaesthesia during imaging procedures such as MRI or during various surgical procedures. Of concern to the anaesthetist is the high prevalence of seizure disorders, gastroesophageal reflux with the risk of aspiration, and airway complications related to poor pharyngeal muscle control and copious oral secretions. In addition, adrenal involvement and hypofunction may be seen in patients with adrenoleukodystrophy. Identification of these associated conditions during the preoperative examination will allow safe anaesthesia for these children.
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PMID:Anaesthetic considerations for the child with leukodystrophy. 156 64

Gastric contents regurgitation into the oesophagus during induction of anaesthesia may easily fail to be recognized. The incidence of this complication was investigated in 59 consecutive patients. They were scheduled for elective thoracic surgery. Anaesthesia was induced with thiopentone (6 mg.kg-1), fentanyl (3 micrograms.kg-1), and either atracurium (0.4 mg.kg-1), vecuronium (0.1 mg.kg-1) or suxamethonium (1.5 mg.kg-1). Oesophageal pH was monitored with an oesophageal pH probe, connected to a portable computer. The pH probe had a virtually instantaneous response time and was positioned in the lower oesophagus. Acid reflux was defined as a decrease in pH to less than 4.0. During the course of induction, three patients (5%) presented an episode of acid reflux. No patient presented any clinical or radiological signs of pulmonary aspiration. This study suggests that monitoring oesophageal pH is a simple method of detecting gastric reflux during the period of induction.
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PMID:Measurement of lower oesophageal pH during induction of anaesthesia: use of oesophageal probe. 157 69

While the number of patients at risk for vomiting and aspiration has been reported to be high, the incidence of clinically important pulmonary aspiration is low. We sought to define the incidence of gastroesophageal reflux (GER) and to correlate this with the clinical variables of obesity, history of oesophagitis, bucking and changes in body position. Continuous oesophageal pH measurement was used to determine the frequency of gastroesophageal reflux in 44 patients having general anaesthesia for elective surgical procedures. Acid reflux to a pH value of less than four occurred in seven patients (15.9%) during anaesthesia. This was associated temporally with straining on the endotracheal tube in six subjects (13.6%). We conclude that traditional risk factors are not always predictive of those patients at risk of regurgitation and aspiration.
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PMID:Gastroesophageal reflux during anaesthesia. 159 71

Acinetobacter calcoaceticus var. anitratus (ACA) was isolated from two newborn infants and var. Iwoffi of the same species from a third patient within a month in the neonatal unit of a general hospital at Metropolitan Santiago, Chile. The first isolate was obtained from a neonate with infection of the skin surrounding a colostomy operation after surgery for tracheo esophageal fistulae, in march 1989. The second case's skin became colonized after he was admitted for surgical repair of severe gastroesophageal reflux into the same ward room and nursed in proximity to the first case, making necessary the use of antibiotic prophylaxis with sulbactam-ampicillin prior to surgery. The third case, a very immature female baby, was born at the same month; she had early septicaemia due to Acinetobacter calcoaceticus var. Iwoffi sensitive to gentamicin and after appropriate treatment her clinical recovery was uneventful. In the microbiological study of the neonatal unit this last microorganism was isolated from thermometers of the nursery and on the hands of one member of the nursing staff, while ACA had been reported at the preceding month from operating rooms and anesthesia equipment. Intensive surveillance of ward's environment, equipment and personnel, barrier precautions, and improved staff handwashing were then instituted and extension of an outbreak was thus avoided.
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PMID:[Acinetobacter in a metropolitan neonatal unit: clinical and microbiological aspects]. 184 63

Gastrostomy is frequently required in children with neurological impairment and feeding disability. In some centers, concomitant (prophylactic) antireflux procedures are often performed due to the increased risk of occurrence of significant gastroesophageal reflux (GER) after isolated operative or percutaneous endoscopic gastrostomy placement. This has been documented in both experimental and clinical settings. A recent clinical study suggests that placement of a gastrostomy in a lesser curvature location rather than on the greater curvature of the stomach may decrease the incidence of postoperative GER. The purpose of this study is to evaluate this clinical impression. Under ketamine anesthesia and sterile technique, 30 cats underwent laparotomy and placement of a Stamm gastrostomy tube; 15 (group A) were located on the greater curvature of the stomach. Each animal was evaluated postoperatively for the occurrence of GER using upper gastrointestinal contrast study, nuclear medicine gastric scintigraphy (technetium 99m), pH probe/Tuttle test, and lower esophageal sphincter (LES) manometrics. Contrast esophagram with barium demonstrated GER in 3 animals in group A and none in group B (P less than .05). The pH/Tuttle test was positive in 4 animals in group and none in group B (P less than .05). 99mTc gastric scintigraphy (over a 30-minute period) demonstrated GER in 7 cats in group A and in only 1 cat in group B (P less than .05). LES manometric pressures were similar among both groups. This study suggests that a gastrostomy placed in the lesser curvature may reduce the incidence of postgastrostomy GER and obviate the need for a concomitant antireflux procedure in patients with a severe feeding disability but without demonstrable GER during preoperative assessment.
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PMID:Lesser curvature gastrostomy reduces the incidence of postoperative gastroesophageal reflux. 191 93

An oesophageal pH electrode was used to record gastro-oesophageal reflux in 73 women who had elective laparoscopy for various gynaecological procedures. No refluxes were recorded during the 63 procedures from which results could be analysed; the upper 95% confidence limit from this observation is 3 in 63 (4.8%). Two of the excluded women refluxed during episodes of hiccough that occurred shortly after induction of anaesthesia. Tracheal intubation may be required during laparoscopy, although the need to protect against the possibility of aspiration of gastric contents may not be a valid reason unless, with the same logic, it is suggested that all patients who hiccough should be intubated.
Anaesthesia 1990 Dec
PMID:Gastro-oesophageal reflux during elective laparoscopy. 214 3

In an attempt to explain the discrepancy between the high number of patients said to be at risk of aspiration pneumonitis and the low reported incidence of this anaesthetic complication, 100 ASA physical status I-II elective surgical patients were studied. The volume of fluid present in the stomach at the time of induction of anaesthesia was correlated with gastroesophageal reflux (GER) detected by visual inspection of the pharynx and by continuous measurement of upper oesophageal pH. Mean gastric volume was 30 +/- 28 ml (range 0-210 ml). Gastric fluid volume greater than or equal to 0.4 ml.kg-1 at pH less than or equal to 2.5 was present in 46 patients. No GER was detected during induction of anaesthesia in our sample of 100 patients. Furthermore, patient age, duration of preoperative fasting, body mass index, cigarette smoking, alcohol consumption, preoperative anxiety, and a history of preoperative GER were not correlated with significant modifications of gastric volume or pH. We conclude that the low incidence of aspiration pneumonitis in elective surgical patients may be explained in part by the very low risk of GER, despite gastric fluid volumes of more than 0.4 ml.kg-1 in a high proportion of this patient population.
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PMID:Occurrence of gastroesophageal reflux on induction of anaesthesia does not correlate with the volume of gastric contents. 237 55

Gastro-oesophageal reflux during a 40-minute reflux provocation test was assessed by lower oesophageal pH monitoring in 25 pregnant women at term, and again on about the second day after delivery. At term 17 women refluxed a total of 29 times; after delivery five women refluxed once each. There was a significant decrease in gastro-oesophageal reflux by the second day after delivery (p less than 0.05). Gastro-oesophageal reflux is, however, only one of the factors that predisposes to acid aspiration pneumonitis.
Anaesthesia 1989 Oct
PMID:Gastro-oesophageal reflux in pregnancy at term and after delivery. 258 5

Since 1948, when the first patient with oesophageal atresia and a tracheo-oesophageal fistula was treated successfully at the Royal Children's Hospital, Melbourne, 569 infants with one or both conditions have been managed at that institution. The mortality rate in those in whom surgical repair of the oesophageal atresia and distal tracheo-oesophageal fistula was attempted has declined from 55% in the first 10 years to less than 1% in the last 10 years of the series. Earlier diagnosis and improvements in resuscitation, transport, neonatal intensive care, anaesthesia, the treatment of associated anomalies and surgical technique all are likely to have contributed to the decline in the mortality and morbidity rates. Problems which remain unresolved in part relate to the aetiology and embryogenesis of oesophageal atresia, the management of long-gap atresia, and the treatment of gastro-oesophageal reflux and tracheomalacia. This article outlines the improvements in management which have occurred already and speculates about what the future may hold.
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PMID:Developments in the management of oesophageal atresia and tracheo-oesophageal fistulas. 272 5

Gastroesophageal reflux may predispose patients to pulmonary complications such as bronchospasm and aspiration pneumonitis. This is especially true in patients who are critically ill, those with reflux-induced asthma and those undergoing general anesthesia. Decreasing the amount of acid reflux reduces the potential for respiratory complications. In patients at risk, administration of H2-receptor antagonists minimizes the risk of acid aspiration and resolves asthma symptoms.
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PMID:Respiratory complications of gastroesophageal reflux. 289 46


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