Gastroesophageal reflux and tracheobronchial contamination after cardiac surgery: should a nasogastric tube be routine?

Anesthesia and Analgesia
G N RussellW I Weir

Abstract

Nasogastric (NG) tubes are routinely used in patients undergoing cardiac surgery. This randomized study was designed to assess gastroesophageal reflux (GER) without a NG tube (control) compared with a NG tube managed either by gravity drainage (gravity) or continuous low-grade suction (suction). Antimony pH probes were placed in the lower esophagus and trachea after induction of anesthesia in 51 patients, and pH was recorded every 5 s until the time of tracheal extubation. GER was defined as reversible decrease in esophageal pH to less than 4.0. No significant difference was found between groups in age, weight, gender, duration of postoperative ventilation, morphine use, or antiemetic use. All indicators of GER were seen more frequently in the gravity group compared with the two other groups (P < 0.001). One episode of sudden decrease in tracheal pH was observed in a patient in the gravity group, indicating tracheal aspiration, which was associated with delayed extubation and postoperative pneumonia. The absence of a NG tube is not associated with reflux, probably since the gastroesophageal sphincter remains competent. NG tubes are not routinely necessary for cardiac surgery in patients without risk factors for GER, and increas...Continue Reading

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Citations

Aug 28, 2009·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Pierre Drolet
Sep 21, 2007·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Mohan P DevbhandariTimothy L Hooper
May 16, 2000·Critical Care Medicine·S R Leal-NovalJ Loscertales-Abril
Feb 5, 2015·Dimensions of Critical Care Nursing : DCCN·Marilyn SchallomJanet Pierce
Aug 8, 2009·The Journal of Thoracic and Cardiovascular Surgery·Ben DaviesPatrick Yiu
Nov 12, 2016·The Linacre Quarterly·Matthew C Lynch
Apr 9, 2008·Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition·Panagiotis H PanagiotakisJohn C Fang
Oct 31, 2002·JPEN. Journal of Parenteral and Enteral Nutrition·Frederick A Moore
Jul 6, 2014·Interactive Cardiovascular and Thoracic Surgery·Pavlos PapoulidisUday Dandekar

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