pancuronium and Gastroesophageal-Reflux

Continuous monitoring of distal oesophageal pH and oesophagoscopy were performed in 28 children aged 15 days to 12 years (mean: 14 months) intubated and ventilated for bronchiolitis (7), pneumonia (8), epiglotitis (2), neurological distress (8), whooping cough (2) or recurrent apneic spells (1). Esophageal pH was studied 2-8 days (mean: 2 days) after intubation; its duration was 12-23 h 50 min (M: 22 h). An abnormal gastroesophageal reflux was presumed when the percent of total monitoring time during which the esophageal pH fell below 4.0 was above 5.2%. The esophagoscopy was carried out on the day following the pH monitoring. All children were in the supine position and fed a pH 7 diet infused continuously with a nasogastric tube; 15 children were under pancuronium. An abnormal gastroesophageal reflux was found in 4 children, associated with a benign esophagitis in 2. A benign esophagitis without gastroesophageal reflux was found in 3 cases. One child had a peptic ulcer of the bulb without gastroesophageal reflux nor oesophagitis. 21 children had no abnormality. Only one of the 15 children under pancuronium had an abnormal gastroesophageal reflux. We conclude that in intubated children fed continuously with a nasogastric tube, gastroesophageal reflux is unfrequent and, when present, appears to have little consequences.

Topics: Enteral Nutrition; Esophagoscopy; Esophagus; Gastric Acidity Determination; Gastroesophageal Reflux; Humans; Hydrogen-Ion Concentration; Infant; Infant, Newborn; Intubation, Intratracheal; Monitoring, Physiologic; Pancuronium; Prospective Studies; Respiration, Artificial

A method of 'crash induction' using pancuronium and thiopentone was studied in 100 patients at risk from vomiting or regurgitation. The technique was inferior to thiopentone/suxamethonium in terms of time to intubation, activity of vocal cords and responses to stimuli during induction. Six cases gave difficulty with intubation due to poor relaxation. Only two patients had a fall in systolic blood pressure of more than 20% following induction. No regurgitation occurred. The technique may be suitable for skilled anaesthetists in cases when suxamethonium is relatively contraindicated, when large doses of pancuronium can be used or when hypotension is likely to follow induction.

Topics: Adolescent; Adult; Aged; Anesthesia, General; Anesthesia, Intravenous; Female; Gastroesophageal Reflux; Humans; Intubation, Intratracheal; Male; Middle Aged; Pancuronium; Succinylcholine; Thiopental; Time Factors