Mustafa SARIOĞLU, Yunus ÜNAL, Tülay KORKMAZ

Gastroskopi öncesi açlık süresinin gastrik rezidü ve ph üzerine etkisi

Amaç: Anestezi ve sedasyon öncesi asit aspirasyon riskini azaltmak için 6-8 saatsüre ile hastaların aç kalması gereklidir. Bu çalısmada gastrik yakınması olup elektifgastroskopi planlanan olgularda islemden 2 saat önce oral verilen karbonhidrat veelektrolitden zengin berrak sıvının gastrik pH ve gastrik rezidü üzerine etkileriniarastırmayı amaçladık Gereç ve Yöntem: Etik kurul izni ve bilgilendirilmis gönüllü onay formu alındıktansonra, elektif gastroskopi planlanan, 18-70 yas arasındaki 80 olgu rasgele 2 grubaayrıldı. Çalısma grubundaki (grup Ç, n=40) olgular 6 saat katı ve sıvı gıda yönündenaç bırakılırken islemden 2 saat önce 400 ml karbonhidrattan zengin bir ürün olan(PreOp® - Nutricia, 240 mOsm/l, %12,5 karbonhidrat, 50 kcal/100 mL, 0.5 mg/ ml sodyum, 1,22mg/ml potasyum) solüsyon oral verildi. Kontrol grubu ise (grup K,n=40) 6 saat süre ile aç bırakıldı. Monitorizasyon sonrası %1 propofol kooperasyonve kirpik refeksi kaybolana kadar iv yoldan verilerek endoskopi islemine baslandı.Endoskopi islemi sırasında mide içeriği aspire edildi, miktarı ve pH değeri ölçüldü.Bütün hastalardan helikobakter pylori tanısı için gastrik biopsi alındı. Bulgular: Gastrik pH değeri Grup Ç’de kontrol grubuna göre daha yüksek bulundu.Gruplar arasında gastrik rezidü yönünden fark gözlenmedi. Grupların gastrik rezidü>0.4 mL/kg ve pH

Effects on gastric residue and ph of fasting period before gastroscopy

Purpose: Fasting for at least 6-8 hours before anesthesia or sedation is mandatory to reduce the risk of aspiration. The aim of this study is to investigate the effects of carbohydrate and electrolyte mixture, given two hours before the gastroscopy procedure, on gastric pH and gastric residue in patients with gastric complaints Material and Method: After the Ethic Committee approval and Informed Consent Forms were obtained. 80 patients who aged between 18-70 and undergo elective gastroscopy under propofol anesthesia were randomly divided into two groups. The patients were fasted for 6 hours in control (Group K, n=40) and study groups (Group Ç, n=40). The patients in the study group were given 400 ml oral fuid rich in carbohydrates (PreOp® - Nutricia, 240 mOsm/l, %12,5 carbohydrate, 50 kcal/100 mL, 0.5 mg/ml Natrium, 1,22mg/ml Potassium) 2 hours before the procedure. 1% propofol was injected until the cooperation and eyelash refex disappeared and then the endoscopy was started. During the procedure, upon entering the stomach, the gastric content was aspirated; total amount and pH of the aspirated material were recorded. In all patients mucosal biopsies were taken for diagnosis of Helicobacter Pylori. Results: Gastric pH value was higher in study group than in control group. No difference was found between the groups with regard to gastric residue volume. The number of the patients with gastric residue >0.4 mL/kg and pH

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1. Practice guidelines for preoperative fasting and the use of pharmaco- logic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: a report by the American Society of Anesthesiologist Task Force on Preoperative Fasting. Anesthesiology 1999; 90: 896-905.
2. Søreide E, Eriksson LI, Hirlekar G, et al. Pre-operative fasting guide- lines: an update. Acta Anaesthesiol Scand 2005; 49: 1041-1047.
3. Engelhardt T, Webster NR. Pulmonary aspiration of gastric contents in anesthesia. Br J Anaesth 1999; 83: 453-460.
4. Splinter WM, Schaefer JD. Unlimited fuid ingestion two hours be- fore surgery in children does not affect volume or pH of stomach contents. Anaesth Intens Care 1990; 18: 522-526.
5. Ng A, Smith G. Gastroesophageal refux and aspiration of gastric contents in anesthetic practice. Anesthesia & Analgesia 2001; 93: 494-513.
6. Feldman M, Cryer B, Lee E. Effects of helicobacter pylori gastritis on gastric secretion in healthy human beings. Am J Physiology 1998; G1011- 1017.
7. Kato S, Ozawa K, Koike T, et al. Effect of helicobacter pylori infection on gastric acid secretion and meal-stimulated serum gastrin in children. Helicobacter 2004; 9: 100-105.
8. Geller E. From oral midazolam to propofol: a perspective. Gastrointestinal Endoscopy 2005; 61: 201-203.
9. Waring PJ, Baron TH, Hirota WK, et al. Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy. Gastrointestinal Endoscopy 2003; 58: 317-322.
10. Greenfeld SM, Webster GJ, Brar AS, et al. Assessment of residual gastric volume and thirst in patients who drink before gastroscopy. Gut 1996; 39:360-362.
11. Gisbert JP, de Pedro A, Losa C, et al. Helicobacter pylori and Gastroesophageal Refux Disease J Clin Gastroenterol 2001;32:210–214.
12. Sharma P, Vakıl N. Helicobacter pylori and refux disease. Aliment Pharmacol Ther 2003; 17: 297-305.
13. Hausel J, Nygren J, Lagerkranser M, et al. A Carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Anesth Analg 2001; 93: 1344-1350.
14. Schwartz DA, Connelly NR, Theroux CA, et al. Gastric contents in children presenting for upper endoscopy. Anesth Analg 1998; 87: 757-760.
15. Nygren J, Thorell A, Jacobsson H, et al. Preoperative gastric emp- tying effects of anxiety and oral carbohydrate administration. Ann Surg 1995; 222: 728-734.