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Paper summary: The effect of omeprazole on oesophageal pH in dogs during anaesthesia

The effect of omeprazole on oesophageal pH in dogs during anaesthesia 

Panti et al. 2009. Journal of Small Animal Practice. 50(10): 540-544

What did the research find?

In the population studied, 1mg/kg omeprazole, administered orally and at least 4 hours preoperatively, reduced the incidence of gastro-oesophageal reflux (GOR) during anaesthesia.

How was it conducted?

As gastric pH is one of the factors that controls gastro-oesophageal sphincter tone (Castell, 1975), this study hypothesised that the pre-anaesthetic administration of omeprazole would reduce the incidence of GOR in dogs undergoing anaesthesia through inhibition of gastric acid production. As such, the primary aim of this study was to investigate the effect of preoperative administration of omeprazole on oesophageal pH in anaesthetised dogs.

In this prospective, blinded, case-controlled study, 47 healthy dogs (ASA physical status I-II) undergoing elective pelvic limb surgery were randomly allocated to either a treatment group (n=22, administered 1mg/kg omeprazole orally at least 4 hours preoperatively) or control group (n=25). Patients with a history of reflux, regurgitation, vomiting or other gastrointestinal disturbances were excluded from enrolment.

All dogs were anaesthetised using the same standardised protocol. Following induction in each case, an oesophageal pH probe was placed via the same technique and by the same operator who was blinded to group allocation. Parameters were recorded every five minutes during anaesthesia. Time of reflux was also recorded. Reflux was defined as an abrupt decrease in oesophageal pH below 4.

Results

Signalment, ventilatory strategy, recumbency and duration of anaesthesia varied between cases. Statistical analysis failed to demonstrate an effect of gender, recumbency or ventilatory strategy on the occurrence of GOR. 

In this model, the best predictor for the probability of reflux was omeprazole administration. GOR was observed less frequently in the treatment group (4 dogs = 18%) than in the control group (13 dogs = 52%, odds ratio: 4·7, P-value = 0.032). Treatment with omeprazole was associated with a lower relative risk of 0.35 and a relative risk reduction of 65%. The number needed to treat was 2.95.

Most dogs that refluxed also regurgitated. None of the patients that either refluxed and/or regurgitated perioperatively demonstrated any clinical signs of oesophagitis and/or aspiration pneumonia 48 hours postoperatively.

Why is it important?

GOR during anaesthesia is considered to be one of the main causes of oesophagitis and may also lead to complications such oesophageal stricture formation in susceptible patients. GOR is clinically silent although it has been reported to occur in up to 41% of dogs undergoing abdominal surgery, and from 16-50% of dogs that undergo anaesthesia with or without surgery being performed (Garcia et al. 2013; Galatos and Raptopoulos, 1995a; Galatos and Raptopoulos, 1995b; Wilson et al. 2005). 

Regurgitation has been defined as the ‘visible’ passage of gastric contents into the oropharynx (Mendelson, 1946), and is therefore considered to be a visible marker of GOR. As well as contributing to the development of oesophagitis and possible stricture formation, regurgitation is also associated with the development of conditions such as rhinitis, chronic cough and aspiration pneumonia (Pearson et al. 1978; Wilson and Walshaw, 2004).

This study suggests that the preoperative administration of omeprazole is effective in reducing the incidence of gastro-oesophageal reflux during anaesthesia in dogs. As such, it would seem appropriate to consider such measures in populations of patients where risk of GOR is considered high. 

Article by
Dr. Dan Cripwell
BSc (Hons) BVSc CertAVP (EM) PgCert (VPS) MRCVS

Veterinary Technical Advisor UK
RCVS Recognised Advanced Veterinary Practitioner

Originally published: Thursday, 28th March 2019

References

Castell D.O. 1975. The lower esophageal sphincter: physiologic and clinical aspects. Annals of internal medicine. 83(3): 390-401.

Galatos A.D., Raptopoulos D. 1995a. Gastro-oesophageal reflux during anaesthesia in the dog: the effect of age, positioning and type of surgical procedure. The Veterinary Record. 137(20): 513-516.

Galatos A.D., Raptopoulos D. 1995b. Gastro-oesophageal reflux during anaesthesia in the dog: the effect of preoperative fasting and premedication. The Veterinary Record. 137(19): 479-483.

Garcia C., Pinchbeck G.L., Dugdale A., Senior J.M. 2013. Retrospective study of the risk factors and prevalence of regurgitation in dogs undergoing general anaesthesia. The Open Veterinary Science Journal. 7(1). 6-11.

Mendelson C.L. 1946. The aspiration of stomach contents into the lungs during obstetric anesthesia. Obstetrical & Gynecological Survey. 1(6): 837-839.

Pearson H., Darke P.G.G., Gibbs C., Kelly D.F., Orr C.M. 1978. Reflux oesophagitis and stricture formation after anaesthesia: a review of seven cases in dogs and cats. Journal of Small Animal Practice. 19(1‐12): 507-519.

Wilson D.V., Walshaw, R. 2004. Postanesthetic esophageal dysfunction in 13 dogs. Journal of the American Animal Hospital Association. 40(6): 455-460.

Wilson DV, Evans AT, Miller RA. 2005. Effects of preanesthetic administration of morphine on gastroesophageal reflux and regurgitation during anesthesia in dogs. American Journal of Veterinary Research. 66: 386-90.

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