Acid suppression in the perioperative period

Joseph R. Pisegna, Robert Martindale

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Aspiration of oropharyngeal and gastric contents during surgery, although infrequent, is a recognized complication of general anesthesia that carries significant risk for serious complications. Complications of aspiration have been reported to cause 10% to 30% of anesthesia-related deaths. Unconsciousness interferes with multiple biologic mechanisms that guard the airway against aspiration, and this is compounded in surgery by anesthesia-induced neurologic impairment and the risks related to placement of nasogastric and endotracheal tubes. Consequences of anesthesia-related aspiration include aspiration pneumonia, acute respiratory distress syndrome, pulmonary edema, and long-term complications such as laryngotracheal damage and decreased lung compliance. Therefore, averting aspiration, particularly in the elderly and other high-risk patients, should be part of the perioperative plan. Although antacids and histamine2-receptor antagonists have been used perioperatively with some success, they are limited by short duration of action and systemic side effects, among other factors. Proton pump inhibitors are currently being investigated in surgical patients at risk for aspiration or stress ulcers and seem to be potent, extremely effective, and well tolerated. This article reviews the risks for, and potential outcomes of, anesthesia-related aspiration, identifies high-risk populations, and outlines the experience to date with available preventive treatments.

Original languageEnglish (US)
Pages (from-to)10-16
Number of pages7
JournalJournal of Clinical Gastroenterology
Volume39
Issue number1
StatePublished - Jan 2005
Externally publishedYes

Fingerprint

Perioperative Period
Acids
Anesthesia
Lung Compliance
Aspiration Pneumonia
Antacids
Gastrointestinal Contents
Unconsciousness
Proton Pump Inhibitors
Adult Respiratory Distress Syndrome
Pulmonary Edema
General Anesthesia
Nervous System
Ulcer
Population

Keywords

  • Acid suppression
  • Aspiration pneumonitis
  • Intravenous proton pump inhibitor
  • Perioperative period

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Acid suppression in the perioperative period. / Pisegna, Joseph R.; Martindale, Robert.

In: Journal of Clinical Gastroenterology, Vol. 39, No. 1, 01.2005, p. 10-16.

Research output: Contribution to journalArticle

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