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GASTROESOPHAGEAL REFLUX IN SEDATED PATIENTS WITH COPA

Department of Anaesthesia, Shimada Municipal Hospital, Noda 1200-5, Shimada, Shizuoka, 427-8502 Japan

INTRODUCTION

Cuffed oropharyngeal airway (COPA) is useful for spontaneously breathing patients. However, once regurgitation occurs, serious aspiration may easily develop due to the shape of the COPA. Thus, we measured pharyngeal and lower esophageal pH in sedated patients with COPA under spinal anesthesia.

METHODS

With IRB and informed consent, we studied 35 adult patients scheduled for hip, knee joint, or prostate surgery. After inducing spinal anesthesia with hypobaric tetracaine, we sedated patients with minimal doses of intravenous diazepam and propofol, and inserted the COPA. Propofol 3.0-4.0 mg•kg^-1•h^-1, was infused and the patients breathed spontaneously during the surgery. In 29 patients, we measured pharyngeal pH every 2.5 min until the patient awoke, using the probe for pH (Zeinetics Med. Inc.) affixed to the convex side of the COPA. In six patients, we measured lower esophageal pH continuously during the patient's emergence period, using pH catheter (Medtronics Inc.).

RESULTS

The median values of pharyngeal pH immediately after the insertion of COPA, at the lowest value during anesthesia, and at the end of anesthesia were 5.4, 4.8*, and 5.0, respectively (*P <0.01 vs. two other values with Friedman's test). In three patients, pH decreased below 4.0 and returned to a value above 4.0 gradually during the surgery. The lower esophageal pH was below 4.0 in one patient when the surgery was completed. The pH decreased transiently below 4.0 in five patient when the patient awoke and the COPA was removed. No patients developed clinical signs of complications due to reflux postoperatively.

DISCUSSION

There was a 10% incidence of pharyngeal reflux, which is higher than the previously reported incidents in spontaneously breathing anesthetized patients with face mask or laryngeal mask. Although premedication with atropine, higher age, and the head-down position may have caused reflux, it is possible that distension of the pharynx due to the COPA cuff reflexively decreased the action of the lower esophageal sphincter as supposed as in the case of laryngeal mask. Further studies are required to establish the safe use of COPA.

REFERENCES

1 Anesth Analg 82:254,1996[Abstract]

2 Br J Anaesth 82:560,1999

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