Perioperative gastroesophageal regurgitation in patients with elevated abdominal pressure with nasogastric tubes? A simulation model based on esophageal multichannel intraluminal impedance and pH monitoring

Abstract

Increased abdominal pressure is common in obese patients and predisposes them to gastroesophageal regurgitation (GER). To drain GER and prevent aspiration, nasogastric (NG) tubes are frequently inserted in obese patients undergoing general anesthesia. However, whether gastric drainage actually decreases the occurrence of GER remains to be elucidated. In this study, increased abdominal pressure was simulated with laparoscopic pneumoperitoneum and Trendelenburg (LPT) positioning, while the retained NG tube was replaced by a pre-inserted esophageal multichannel intraluminal and pH (MII-pH) monitoring. Fifteen patients undergoing elective gynecologic laparoscopy were enrolled in this study. Thirteen patients (86%) developed GER while in the LPT position. With the high occurrence of GER, pre-inserted NG tubes under general anesthesia are not likely to be protective in obese patients.

Keywords: Gastroesophageal regurgitation; Laparoscopic pneumoperitoneum and trendelenburg positioning; Multichannel intraluminal impedance and pH monitoring; Obesity.