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ANESTHETIC PHARMACOLOGY

Gastroesophageal Reflux and Tracheal Aspiration in the Thoracotomy Position: Should Ranitidine Premedication be Routine?

Neil M. Agnew, FRCA^*, Jonathan B. Kendall, FRCA^*, Maria Akrofi, FRCA^*, Jane Tran, BTech, Ajaib S. Soorae, FRCS, Richard Page, FRCS, Glenn N. Russell, FRCA^*, and Stephen H. Pennefather, FRCA^*

Departments of *Anaesthesia, Respiratory Measurement, and Surgery, The Cardiothoracic Centre, Liverpool, United Kingdom

Address correspondence and reprint requests to Jonathan B. Kendall, FRCA, Department of Anaesthesia, The Cardiothoracic Centre, Thomas Dr., Liverpool L14 3PE, England. Address e-mail to jbkendall{at}doctors.org.uk

Aspiration of gastric contents may contribute to pulmonary complications after thoracotomy. The incidence of gastroesophageal reflux (GER) and tracheal acid aspiration in patients undergoing thoracotomy in the lateral position is unknown. Ranitidine premedication reduces gastric volume, increases gastric pH, and may reduce GER. We used continuous intraluminal esophageal and tracheal pH monitoring probes to investigate the effect of ranitidine on the incidence of GER and tracheal aspiration in 80 adult patients undergoing thoracotomy. The study was placebo-controlled, randomized, and double-blinded. Patients at high risk of GER were excluded from the study. The incidence of acid GER in the placebo and ranitidine groups was 28.2% and 2.5%, respectively (P = 0.006). Multiple episodes of GER occurred in some patients in the placebo group only. The total number of episodes of GER in the placebo and ranitidine groups was 16 and 1, respectively (P = 0.002). The incidence of tracheal acid aspiration in the placebo and ranitidine groups was 7.7% and 2.5%, respectively (not significant). Patients undergoing thoracotomy are therefore at high risk of acid GER, which may lead to tracheal acid aspiration in an appreciable proportion. Premedication with ranitidine significantly reduces, but does not eliminate, the incidence of this potentially life-threatening complication.

IMPLICATIONS: Gastroesophageal reflux (GER) and tracheal aspiration of acid may increase morbidity and mortality in patients undergoing thoracotomy. This randomized, double-blinded, placebo-controlled study demonstrates frequent incidences of both acid GER and tracheal acid aspiration during surgery that are significantly reduced by premedication with ranitidine.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999