Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942004000100005
Brazilian Journal of Anesthesiology
Scientific Article

Volume gástrico residual e risco de aspiração pulmonar em crianças com refluxo gastroesofágico: estudo comparativo

Residual gastric volume and risk for pulmonary aspiration in children with gastroesophageal reflux: comparative study

Marcos Guilherme Cunha Cruvinel; Paulo Fernando Souto Bittencourt; José Roberto de Rezende Costa; Paulo Roberto Vieira Barbosa

http://dx.doi.org/10.1590/S0034-70942004000100005 Braz J Anesthesiol, vol.54, n1, p.37-42, 2004
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Resumo

JUSTIFICATIVA E OBJETIVOS: Freqüentemente, crianças com refluxo gastroesofágico têm que ser submetidas a anestesia para estudos diagnósticos e/ou procedimentos cirúrgicos. Considera-se que o esvaziamento gástrico seja retardado na doença do refluxo gastroesofágico pediátrico. Portanto, a anestesia nesses pacientes tem aspectos peculiares, especialmente no que se refere ao risco de aspiração pulmonar. O objetivo deste estudo é comparar o volume gástrico residual de crianças com ou sem refluxo gastroesofágico e determinar se as crianças com refluxo têm, de fato, risco aumentado para a aspiração pulmonar do conteúdo gástrico durante a anestesia. MÉTODO: Participaram do estudo 38 crianças, estado físico ASA I ou II, submetidas à endoscopia digestiva alta diagnóstica. As crianças foram divididas em dois grupos: grupo R, portadoras de refluxo gastroesofágico e grupo N, sem refluxo gastroesofágico com endoscopia digestiva alta normal. Durante o procedimento, todo o conteúdo gástrico foi aspirado e seu volume medido. RESULTADOS: Das 38 crianças estudadas, 18 (47%) foram incluídas no grupo R e 20 (53%) no grupo N. Não foram constatadas diferenças significativas entre os dois grupos no que se refere à idade, ao peso e tempo de jejum. Em todos os pacientes, o volume gástrico residual observado foi inferior a 0,4 ml.kg-1; e não houve diferenças significativas entre os grupos. CONCLUSÕES: Nas condições deste estudo, o volume gástrico residual não diferiu entre as crianças portadoras, ou não, de refluxo gastroesofágico. Portanto, as crianças com refluxo gastroesofágico não apresentaram risco aumentado de aspiração pulmonar, quando comparadas a crianças sem refluxo gastroesofágico, podendo-se dispensar sua profilaxia.

Palavras-chave

ANESTESIA, Pediátrica, COMPLICAÇÕES, aspiração pulmonar

Abstract

BACKGROUND AND OBJECTIVES: Children with gastroesophageal reflux are often submitted to anesthesia for both diagnostic and therapeutic procedures. They are considered as having delayed gastric emptying and so anesthesia in this group is surrounded by special consideration, mostly with regard to pulmonary aspiration. This study aimed at comparing residual gastric volume of children with and without gastroesophageal reflux and at determining if children with gastroesophageal reflux are at risk for pulmonary aspiration during anesthesia.
METHODS: Participated in this study 38 children, physical status ASA I and II undergoing upper digestive diagnostic endoscopy. Children were distributed in two groups, according to the presence (group R) or absence (group N) of gastroesophageal reflux. All gastric content was collected and measured during the procedure.
RESULTS: There were 18 (47%) group R children and 20 (53%) group N children. Age, weight and fasting time were not significantly different between groups. In all patients, residual gastric volume was less then 0,4 ml.kg-1 and there were no significant differences between groups.
CONCLUSIONS: Children with gastroesophageal reflux were not at increased risk for pulmonary aspiration, as compared to children without reflux. Therefore, its prophylaxis would not be necessary.

Keywords

ANESTHESIA, Pediatric; COMPLICATIONS, pulmonary aspiration: DISEASES, gastroesophageal reflux RESUMEN

Referências

Vandenplas Y, Goyvaerts H, Helven R. Gastroesophageal reflux, as assessed by 24-hour pH monitoring, in 509 healthy infants screened for SIDS risk. Pediatrics. 1991;88:834-840.

Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anesthesia. Amer J Obstetrics Gynaecol. 1946;53:191-205.

Macuco MV. Jejum pré-operatório: validade de critérios. Rev Bras Anestesiol. 1998;48:295-308.

Grenfield LJ, Singleton RP, McCaffree DR. Pulmonary effects of experimental graded aspiration of hydrochloric acid. Ann Surg. 1969;170:74-86.

Roberts RB, Shirley MA. Reducing the risk of acid aspiration during cesarean section. Anesth Analg. 1974;53:859-868.

Splinter WM, Schreiner MS. Preoperative fasting in children. Anesth Analg. 1999;89:80-89.

Phillips S, Daborn AK, Hatch DJ. Preoperative fasting for paediatric anaesthesia. Br Anaesth. 1994;73:529-536.

Olsson GL, Hallen B, Hambreaeus-Jonzon K. Aspiration during anaesthesia: a computer aided study of 185358 anesthetics. Acta Anaesthesiol Scand. 1986;30:84-92.

Eriksson LI, Sandin R. Fasting guidelines in different countries. Acta Anaesthesiol Scand. 1996;40:971-974.

Ferrari LR, Rooney FM, Rockoff MA. Preoperative fasting practices in pediatrics. Anesthesiology. 1999;90:978-980.

A report by the American Society of Anesthesiologists Task Force on Preoperative Fasting. Anesthesiology. 1999;90:896-905.

Cucchiara S, Salvia G, Borreli O. Gastric electrical dysrhythmias and delayed gastric emptying in gastroesophageal reflux disease. Am J Gastroenterol. 1997;92:1103-1108.

Di Lorenzo C, Piepz A, Ham H. Gastric emptying with gastroesophageal reflux. Arch Dis Child. 1987;62:449-452.

Hillemeier A, Lange R, McCallum R. Delayed gastric emptying in infants with gastroesophageal reflux. J Pediatr. 1981;98:190-194.

McCallum R, Berkowitz D, Lerner E. Gastric emptying in patients with gastroesophageal reflux. Gastroenterology. 1981;80:285-289.

Cannon R, Stadalnik R. Postprandial gastric motility in infants with gastroesophageal reflux and delayed gastric emptying. J Nucl Med. 1993;34:2120-2125.

Andrés JM, Mathias JR, Clench MH. Gastric emptying in infants with gastroesophageal reflux. Dig Dis Sci. 1988;33:393-399.

Coté CJ, Todres D, Ryan JF. Preoperative Evaluation of Pediatric Patients. A Practice of Anesthesia for Infants and Children. 2001:37-54.

Goudsouzian NG. Muscle Relaxants in Children. A Practice of Anesthesia for Infants and Children. 2001:196-215.

Stoelting RK. Antacids and Gastrointestinal Prokinetics. Pharmacology and Physiology in Anesthetic Practice. 1999:444-452.

Stoelting RK. Histamine and Histamine Receptor Antagonists. Pharmacology and physiology in anesthetic practice. 1999:385-397.

Stoelting RK. Antacids and Gastrointestinal Prokinetics. Pharmacology and Physiology in Anesthetic Practice. 1999:444-452.

Stoelting RK. Histamine and Histamine Receptor Antagonists. Pharmacology and Physiology in Anesthetic Practice. 1999:385-397.

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