Large volume gastroesophageal reflux: a rationale for risk reduction in the perioperative period

Hardy, Jean‐François

doi:10.1007/bf03010658

Cited by 74 publications

(45 citation statements)

References 90 publications

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“…We used a Ryle’s tube for aspiration of gastric contents which is a well accepted method for assessment. [561314] Our study confirmed the results of previous studies[356] that even after 11-13 h of fasting, a large number of patients had gastric pH < 2.5 and gastric fluid volume >25 ml.…”

Section: Discussionsupporting

confidence: 90%

"Nil per oral after midnight": Is it necessary for clear fluids?

2010

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Fasting before general anaesthesia aims to reduce the volume and acidity of stomach contents, thus reducing the risk of regurgitation and aspiration. Recent guidelines have recommended a shift in fasting policies from the standard ‘nil per oral from midnight’ to a more relaxed policy of clear fluid intake a few hours before surgery. The effect of preoperative oral administration of 150 ml of water 2 h prior to surgery was studied prospectively in 100 ASA I and II patients, for elective surgery. Patients were randomly assigned to two groups. Group I (n = 50) was fasting overnight while Group II (n = 50) was given 150 ml of water 2 h prior to surgery. A nasogastric tube was inserted after intubation and gastric aspirate was collected for volume and pH. The gastric fluid volume was found to be lesser in Group II (5.5 ± 3.70 ml) than Group I (17.1 ± 8.2 ml) which was statistically significant. The mean pH values for both groups were similar. Hence, we conclude that patients not at risk for aspiration can be allowed to ingest 150 ml water 2 h prior to surgery.

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Section: Discussionsupporting

confidence: 90%

"Nil per oral after midnight": Is it necessary for clear fluids?

2010

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“…Markedly elevated gastric fluid volume, increased intra-abdominal pressure and gastroesophageal reflux are factors of greater clinical relevance. ~3, 14 An unexpected finding was the significant increase in gastric fluid volume as age increased. This may represent a normal physiological occurrence, or a chance event or our technique of gastric fluid volume estimation may underestimate small gastric volumes to a greater extent than it underestimates larger volumes.…”

Section: Discussionmentioning

confidence: 98%

Clear fluids three hours before surgery do not affect the gastric fluid contents of children

1990

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Patients are required to abstain from food and drink before surgery. In younger patients the resulting fast of 6 to 18 hours leads to thirsty, hungry and irritable children. 1.2 In order to minimize these discomforts, the optimum length for this fast must be established.Previous studies have demonstrated the safety and efficacy of administering specific volumes (2-10 ml. kg-i) and types (water, apple juice, five per cent dextrose water and 20 per cent Poly-Joule) of clear fluids to children two to three hours before surgery. 1-5 This study of healthy children compared the effect of an overnight fast with the effect of permitting unlimited clear fluids up to three hours before surgery on gastric fluid volume and pH. MethodsThis study was approved by the Hospital Ethics Committee and parental consent was obtained. Patients were excluded from the study if there was a history of gastrointestinal disease or if the patient was receiving medication known to affect gastric contents.One hundred and twenty-one healthy children aged 2-12 yr scheduled for elective surgery were randomly assigned to one of two groups. Children in Group A fasted from midnight. Children in Group B did not consume solid food on the day of their operation but were instructed to ingest unlimited volumes and types of clear fluids up to three hours before their scheduled surgery. For the purpose of this study clear fluids were defined as aqueous solutions, which are liquids at 37 ~ C. 6'7 Non-clear fluids, suspensions and emulsions, such as milk and most broths, were not permitted. Parents or nursing staff were asked to monitor accurately the amount of fluid ingested on the day of surgery.

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“…Eighty children ages five to ten years, ASA physical status l or 2, scheduled for elective surgery were randomly assigned to one of two groups. Patients were excluded from the study if (1) there was a history of gastrointestinal disease or (2) the patient was on medication known to affect gastric contents. All children were ordered to fast from midnight.…”

Section: Methodsmentioning

confidence: 99%

The effect of preoperative apple juice on gastric contents, thirst, and hunger in children

1989

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The appropriate length of time to withhold solid food and clear fluids in children before surgery is unknown. Children fast for variable periods of time, often according to local custom rather than on scientific principles. The purpose of this fast is to minimize the volume of gastric contents,~ Children are notorious for breaking their fast prior to surgery. This can create havoc in a busy operating room schedule because of delays and may lead to conflicts between patient, family, surgeon and anaesthetist.Prolonged fasting does not decrease gastric volume.2 A short fast after solid food increases gastric volume, 3 but a

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Large volume gastroesophageal reflux: a rationale for risk reduction in the perioperative period

Cited by 74 publications

References 90 publications

"Nil per oral after midnight": Is it necessary for clear fluids?

"Nil per oral after midnight": Is it necessary for clear fluids?

Clear fluids three hours before surgery do not affect the gastric fluid contents of children

The effect of preoperative apple juice on gastric contents, thirst, and hunger in children

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