Wahbeh Ghassan, Rubens Daniel, Katz Jason R, Seidel Kristy, Rampersad Sally E, Murray Karen F
Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Seattle Children's, University of Washington School of Medicine, Seattle, WA 98105, USA.
Paediatr Anaesth. 2010 Jul;20(7):660-5. doi: 10.1111/j.1460-9592.2010.03319.x. Epub 2010 Apr 23.
Graft versus host disease (GVHD) of the gut is thought to delay gastric emptying and so may increase the risk of aspirating retained contents while under anesthesia. Knowing that gastric emptying is delayed in patients with GVHD might lead one to choose to intubate the trachea for all patients with suspected GVHD, who present for diagnostic esophagogastricduodenoscopy (EGD). We are not aware of published data that gives specific guidance as to the need for intubation in the pediatric bone marrow or stem cell transplantation (BMT) population. This review was intended to evaluate the gastric contents (pH and volume) in this group of patients, to provide anesthesiologists with data that would inform their decisions about airway management for these patients.
Retrospective chart review of patients <or=19 years of age undergoing EGD between 2004 and 2006. Gastric content volume and pH were measured in addition to underlying disease state and treatment. We compared BMT patients with suspected GVHD to nontransplant patients with other underlying gastrointestinal conditions.
Data were obtained for 77 patients post-BMT undergoing EGD, including 40 patients whose biopsies and endoscopic findings were positive for GVHD, and 37 patients with no demonstrable GVHD. Records of 144 non-BMT patients undergoing EGD within the same study period were also reviewed.
Patients in the BMT group overall did not have higher volumes when compared to non-BMT patients. A secondary comparison of BMT patients who were found to have GVHD vs BMT patients without GVHD suggests that gastric content volume may be elevated with GVHD. Patients in the BMT group had statistically significantly higher gastric pH than patients in the non-BMT group. It is possible that the higher gastric volume in the GVHD-positive group could put them at slightly higher risk for aspiration, but the severity of any pneumonitis, should aspiration occur, might be mitigated, by the tendency toward a higher gastric pH in the BMT patients.
肠道移植物抗宿主病（GVHD）被认为会延迟胃排空，因此可能增加麻醉时误吸潴留物的风险。了解到GVHD患者胃排空延迟，可能会促使人们为所有疑似GVHD且需接受诊断性食管胃十二指肠镜检查（EGD）的患者选择气管插管。我们尚未发现有已发表的数据能针对儿科骨髓或干细胞移植（BMT）人群的插管需求给出具体指导。本综述旨在评估该组患者的胃内容物（pH值和容量），为麻醉医生提供数据，以便他们为这些患者做出气道管理决策。
对2004年至2006年间接受EGD检查的19岁及以下患者进行回顾性病历审查。除了基础疾病状态和治疗情况外，还测量了胃内容物容量和pH值。我们将疑似GVHD的BMT患者与患有其他基础胃肠道疾病的非移植患者进行了比较。
获取了77例BMT后接受EGD检查患者的数据，其中40例患者的活检和内镜检查结果显示GVHD呈阳性，37例患者未显示有GVHD。同时还审查了同一研究期间144例接受EGD检查的非BMT患者的记录。
与非BMT患者相比，BMT组患者的总体胃内容物容量并不更高。对发现有GVHD的BMT患者与无GVHD的BMT患者进行的二次比较表明，GVHD可能会使胃内容物容量升高。BMT组患者的胃pH值在统计学上显著高于非BMT组患者。GVHD阳性组中较高的胃容量可能会使他们发生误吸的风险略高，但如果发生误吸，由于BMT患者胃pH值较高的趋势，任何肺炎的严重程度可能会减轻。
