Volume and pH of Gastric Contents in Patients Undergoing Gynecologic Laparoscopic Surgery During Emergence From General Anesthesia
NCT ID: NCT03672734
Last Updated: 2019-04-04
Study Results
Results pending
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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Recruitment Status
UNKNOWN
Total Enrollment
100 participants
Study Classification
OBSERVATIONAL
Study Start Date
2018-09-20
Study Completion Date
2019-12-31
Brief Summary
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Complications during general anesthesia,induction period: difficult airway, hypotension, upper airway obstruction, laryngospasm, pulmonary aspiration Maintenance period: hypotension, hypertension, awareness, bronchospasm, pulmonary aspiration.
Emergence period: delayed emergence, upper airway obstruction, pulmonary aspiration.
Pulmonary aspiration occur all ranges of general anesthesia. Because the patients can not protected themselves due to anesthetic medication, example: volatile agent, opioid.This can cause decrease consciousness, delayed gastric emptying time. Incidence of pulmonary aspiration was 1 : 900 - 1 : 10,000 of general of anesthesia (induction 20%, emergence 80%), Anesthesia Service in Siriraj Hospital (2017) 6: 25,000 case Pathophysiology of pulmonary aspiration.
Pulmonary aspiration is defined as inhalation of oropharynx or stomach contents through the larynx to low respiratory tract. Aspiration pneumonitis is the inflammation of the lung caused by aspirating or inhaling irritants (Mendelson's syndrome).
Gastric acid is a digestive fluid formed in the stomach and is composed of hydrochloric acid, potassium chloride, and sodium chloride.The highest concentration of gastric acid is 140-160 mEq/L. The pH of gastric acid is 1.5-3.5 in the human stomach lumen.
Risk factors for increased gastric contents: full stomach, delayed gastric emptying, incompetent lower esophageal sphincter, lithotomy position, laparoscopy, length of surgery more than 2 hr., difficult airway.
This study observed Volume and pH of Gastric Contents in Patients undergoing Gynecologic Laparoscopic Surgery during Emergence from General Anesthesia.
Emergence period: delayed emergence, upper airway obstruction, pulmonary aspiration.
Pulmonary aspiration occur all ranges of general anesthesia. Because the patients can not protected themselves due to anesthetic medication, example: volatile agent, opioid.This can cause decrease consciousness, delayed gastric emptying time. Incidence of pulmonary aspiration was 1 : 900 - 1 : 10,000 of general of anesthesia (induction 20%, emergence 80%), Anesthesia Service in Siriraj Hospital (2017) 6: 25,000 case Pathophysiology of pulmonary aspiration.
Pulmonary aspiration is defined as inhalation of oropharynx or stomach contents through the larynx to low respiratory tract. Aspiration pneumonitis is the inflammation of the lung caused by aspirating or inhaling irritants (Mendelson's syndrome).
Gastric acid is a digestive fluid formed in the stomach and is composed of hydrochloric acid, potassium chloride, and sodium chloride.The highest concentration of gastric acid is 140-160 mEq/L. The pH of gastric acid is 1.5-3.5 in the human stomach lumen.
Risk factors for increased gastric contents: full stomach, delayed gastric emptying, incompetent lower esophageal sphincter, lithotomy position, laparoscopy, length of surgery more than 2 hr., difficult airway.
This study observed Volume and pH of Gastric Contents in Patients undergoing Gynecologic Laparoscopic Surgery during Emergence from General Anesthesia.
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Detailed Description
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The study was approved from the Siriraj Institutional Review Board (Si-IRB), COA (Certificate of Analysis):Si437/2018 and was written informed consent was obtained from all subjects. The study was conducted at the Department of Siriraj Obstetrics and Gynecology.
A total of 100 patients were enrolled in the study between September 2018 and 2019. All patients underwent general anesthesia for elective gynecologic laparoscopic surgery. Inclusion criteria were elective Cases, laparoscopic surgery, age 18-65 year,BMI\<30kg/sq.m. Exclusion criteria were emergency Case, full stomach. Withdrawal or termination criterion was the difficult inserted orogastric tube.
On the day of surgery, participants signed the informed consent. Record data consisted of NPO time, premedication drug, BMI, having intravenous fluid. All patients underwent general anesthesia after application of standard monitors, anesthesia was induced with fentanyl 1-2 mcg/kg. or morphine 0.1-0.2 mg/kg., propofol 1.5-2.5 mg/kg.,nimbex 1-1.5 mg/kg or atracurium 0.6 mg/kg. Anesthesia was maintained with sevoflurane, air, o2.
Gastric volume and PH were measured with PH meter, measured at 1hr. intervals until the end of surgery. Intraoperative, record medication for reduced gastric volume or PH.
Postoperative, data were record nausea or vomiting, medication requirements.
A total of 100 patients were enrolled in the study between September 2018 and 2019. All patients underwent general anesthesia for elective gynecologic laparoscopic surgery. Inclusion criteria were elective Cases, laparoscopic surgery, age 18-65 year,BMI\<30kg/sq.m. Exclusion criteria were emergency Case, full stomach. Withdrawal or termination criterion was the difficult inserted orogastric tube.
On the day of surgery, participants signed the informed consent. Record data consisted of NPO time, premedication drug, BMI, having intravenous fluid. All patients underwent general anesthesia after application of standard monitors, anesthesia was induced with fentanyl 1-2 mcg/kg. or morphine 0.1-0.2 mg/kg., propofol 1.5-2.5 mg/kg.,nimbex 1-1.5 mg/kg or atracurium 0.6 mg/kg. Anesthesia was maintained with sevoflurane, air, o2.
Gastric volume and PH were measured with PH meter, measured at 1hr. intervals until the end of surgery. Intraoperative, record medication for reduced gastric volume or PH.
Postoperative, data were record nausea or vomiting, medication requirements.
Conditions
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General Anesthesia
Study Design
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Observational Model Type
CASE_ONLY
Study Time Perspective
OTHER
Eligibility Criteria
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Inclusion Criteria
* ASA class 1-2,
* 18-65 years old,
* Laparoscopic surgery,
* BMI\<30kg/sq.m.
* 18-65 years old,
* Laparoscopic surgery,
* BMI\<30kg/sq.m.
Exclusion Criteria
* Difficult inserted orogastric tube.
Minimum Eligible Age
18 Years
Maximum Eligible Age
65 Years
Eligible Sex
FEMALE
Accepts Healthy Volunteers
No
Sponsors
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Siriraj Hospital
OTHER
Sponsor Role
lead
Responsible Party
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Warunee Boayam
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol university
Responsibility Role
PRINCIPAL_INVESTIGATOR
Principal Investigators
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Warunede Buayam, B.NS
Role: STUDY_DIRECTOR
Department of Anesthesiology, Faculty of Medicine, Siriraj hospital
Locations
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Waerunee Boayam
Bangkok, , Thailand
Site Status
Countries
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Thailand
References
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Perlas A, Chan VW, Lupu CM, Mitsakakis N, Hanbidge A. Ultrasound assessment of gastric content and volume. Anesthesiology. 2009 Jul;111(1):82-9. doi: 10.1097/ALN.0b013e3181a97250.
Reference Type
BACKGROUND
Ouanes JP, Bicket MC, Togioka B, Tomas VG, Wu CL, Murphy JD. The role of perioperative chewing gum on gastric fluid volume and gastric pH: a meta-analysis. J Clin Anesth. 2015 Mar;27(2):146-52. doi: 10.1016/j.jclinane.2014.07.005. Epub 2014 Nov 28.
Reference Type
BACKGROUND
Schmidt AR, Buehler P, Seglias L, Stark T, Brotschi B, Renner T, Sabandal C, Klaghofer R, Weiss M, Schmitz A. Gastric pH and residual volume after 1 and 2 h fasting time for clear fluids in childrendagger. Br J Anaesth. 2015 Mar;114(3):477-82. doi: 10.1093/bja/aeu399. Epub 2014 Dec 13.
Reference Type
BACKGROUND
Phillips S, Liang SS, Formaz-Preston A, Stewart PA. High-risk residual gastric content in fasted patients undergoing gastrointestinal endoscopy: a prospective cohort study of prevalence and predictors. Anaesth Intensive Care. 2015 Nov;43(6):728-33. doi: 10.1177/0310057X1504300610.
Reference Type
BACKGROUND
Splinter WM. From the Journal archives: gastric fluid volume and pH in elective patients following unrestricted oral fluid until three hours before surgery. Can J Anaesth. 2014 Dec;61(12):1126-9. doi: 10.1007/s12630-014-0220-z. Epub 2014 Aug 15. No abstract available.
Reference Type
BACKGROUND
Goudra BG, Singh PM, Carlin A, Manjunath AK, Reihmer J, Gouda GB, Ginsberg GG. Effect of Gum Chewing on the Volume and pH of Gastric Contents: A Prospective Randomized Study. Dig Dis Sci. 2015 Apr;60(4):979-83. doi: 10.1007/s10620-014-3404-z. Epub 2014 Nov 2.
Reference Type
BACKGROUND
Ong BY, Palahniuk RJ, Cumming M. Gastric volume and pH in out-patients. Can Anaesth Soc J. 1978 Jan;25(1):36-9. doi: 10.1007/BF03006781.
Reference Type
BACKGROUND
Gouda BB, Lydon AM, Badhe A, Shorten GD. A comparison of the effects of ranitidine and omeprazole on volume and pH of gastric contents in elective surgical patients. Eur J Anaesthesiol. 2004 Apr;21(4):260-4. doi: 10.1017/s0265021504004028.
Reference Type
BACKGROUND
Gombar S, Kiran S, Gupta M, Gombar K, Chhabra B. Preanaesthetic oral ranitidine, omeprazole and metoclopramide for modifying gastric fluid volume and pH. Can J Anaesth. 1994 Sep;41(9):879-80. doi: 10.1007/BF03011614. No abstract available.
Reference Type
BACKGROUND
Boulay K, Blanloeil Y, Bourveau M, Geay G, Malinovsky JM. Effects of oral ranitidine, famotidine and omeprazole on gastric volume and pH at induction and recovery from general anaesthesia. Br J Anaesth. 1994 Oct;73(4):475-8. doi: 10.1093/bja/73.4.475.
Reference Type
BACKGROUND
Chang KK, Jawan B, Fung ST, Lee JH. Effect of preoperative fasting time on gastric volume and pH. Ma Zui Xue Za Zhi. 1989 Jun;27(2):149-52.
Reference Type
BACKGROUND
Haavik PE, Soreide E, Hofstad B, Steen PA. Does preoperative anxiety influence gastric fluid volume and acidity? Anesth Analg. 1992 Jul;75(1):91-4. doi: 10.1213/00000539-199207000-00017.
Reference Type
BACKGROUND
Maltby JR, Lewis P, Martin A, Sutheriand LR. Gastric fluid volume and pH in elective patients following unrestricted oral fluid until three hours before surgery. Can J Anaesth. 1991 May;38(4 Pt 1):425-9. doi: 10.1007/BF03007577.
Reference Type
BACKGROUND
Noakes TD, Rehrer NJ, Maughan RJ. The importance of volume in regulating gastric emptying. Med Sci Sports Exerc. 1991 Mar;23(3):307-13.
Reference Type
BACKGROUND
Goetze O, Treier R, Fox M, Steingoetter A, Fried M, Boesiger P, Schwizer W. The effect of gastric secretion on gastric physiology and emptying in the fasted and fed state assessed by magnetic resonance imaging. Neurogastroenterol Motil. 2009 Jul;21(7):725-e42. doi: 10.1111/j.1365-2982.2009.01293.x. Epub 2009 Apr 1.
Reference Type
BACKGROUND
Brocks K, Jensen JS, Schmidt JF, Jorgensen BC. Gastric contents and pH after oral premedication. Acta Anaesthesiol Scand. 1987 Jul;31(5):448-9. doi: 10.1111/j.1399-6576.1987.tb02600.x.
Reference Type
BACKGROUND
Other Identifiers
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328/2561(EC3)
Identifier Type: -
Identifier Source: org_study_id
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