GI - NPO, Aspiration, and GERD

NPO guidelines:

            2hrs: clear liquid

            4hrs: breast milk

            6hrs: infant formula, non-human milk, and light meal (tea, toast ok)

            8hrs: heavy meal (fat)

What if a child chews gum? IF spits it out ok, if swallows = cancel elective surgery if <6hr!



What decreases LES tone?

Parasympatholytics (cholinergics = strengthen, anticholinergics weaken): glyco, atropine; opiods and benzos, thiopental, volatiles, NTG, LMA, DM with autonomic neuropathy

            What meds increase LES tone?

Sux (thought to be due to ach psns +), Metoclopramide (contraindicated in pheo), neostigmine

            Top 10 risk factors of aspiration

EM surgery, inadequate anesthesia, abdominal pathology, obesity, opiod use, neurologic deficit, lithotomy, difficult intubation, reflux, hiatal hernia

Add one the board likes: DMI -> prone to autonomic neuropathy and gastroparesis


What to do if pt aspirates?

                        Tburg, intubate -> SUCTION before giving PPV. Treat like ARDS! No ABX!!

Aspiration pneumonitis and pna


Do any meds prevent aspiration? Clinically NO BENEFIT

However, an acidic aspiration (animal expirements show ph<2.5 and vol 0.4cc/kg are worse outcome ->pneumonitis) is worse than a closer to physiologic aspiration. Therefore we give drugs to help (aspiration

Antacids (sodium citrate) given 15-30min prior to induction increases stomach pH

H2 blockers (cimitidine, famotidine, ranitidine) shown to decrease pH (remember cimetidine is a p450 inhibitor, will prolong drugs of diazepam, chlordiazepoxide, theophylline, propranolol, and lidocaine)

 PPI (omeprazole) deaceases pH, 40 mg of IV omeprazole 30 minutes before

Metaclopramide  (dopamine antagonist) stimulates upper gastrointestinal motility, increases gastroesophageal sphincter tone, and relaxes the pylorus and duodenum. A parenteral dose of 5 to 10 mg is usually given 15 to 30 minutes before induction. (Avoid in pheo, stimulates catecholamine secretion, can have EPS sxs, treat with antiCH) = benztropine, diphenhydramine)


            Advise pts to continue home regimens, could have Fe def anemia, remember abdomen insulation could cause passive regurgitation. If pt is undergoing nissen = full stomach precautions 

A randomized, double-blind, controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of overt hepatic encephalopathy.

taken from 

Tony Clark,
Jun 15, 2016, 4:07 PM