择期膝关节手术麻醉犬采用反特伦德伦堡体位对胃食管反流发生率的影响。

Effect of the reverse Trendelenburg position on the incidence of gastroesophageal reflux in dogs anesthetized for elective stifle surgery.

机构信息

Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, USA.

出版信息

Vet Anaesth Analg. 2023 Jul;50(4):333-340. doi: 10.1016/j.vaa.2023.04.002. Epub 2023 Apr 15.

DOI:10.1016/j.vaa.2023.04.002

PMID:37164789

Abstract

OBJECTIVE

To determine if a 15° reverse Trendelenburg position decreases the incidence of gastroesophageal reflux (GER) compared with a horizontal position in dogs anesthetized for stifle surgery.

STUDY DESIGN

Prospective, randomized parallel-arm study.

ANIMALS

A total of 44 healthy client-owned dogs were enrolled and data from 36 dogs were analyzed.

METHODS

Dogs requiring preoperative radiographs under anesthesia, or with a history of gastrointestinal signs or administered gastroprotectant therapy within 1 month of surgery were excluded. Anesthesia protocol was standardized to include hydromorphone, dexmedetomidine, ketamine, propofol and isoflurane. Dogs were randomly assigned at enrollment to be positioned in a 15° reverse Trendelenburg or a horizontal position for surgery. Continuous pH monitoring was documented throughout the procedure with a 6.4 Fr (2.13 mm) esophageal pH probe positioned in the distal esophagus via the oral cavity. GER was defined as pH < 4.0 (acidic) or > 7.5 (alkaline) for more than 30 seconds. The proportions of dogs developing GER were compared between groups using Fisher's exact test. Time to reflux was compared using survival curves and the Gehan-Breslow-Wilcoxon test. Statistical significance was set as p < 0.05.

RESULTS

An episode of GER occurred in 11/36 (30%) dogs. Reflux was alkaline in two dogs and acidic in nine dogs. The proportion of dogs with GER was 5/18 (28%) and 6/18 (33%) for dogs in the reverse Trendelenburg position and horizontal position, respectively, and was not statistically significant (p > 0.99). Median (range) time until reflux was 44 (23-135) and 44.5 (9-56) minutes when dogs were positioned in reverse Trendelenburg position and horizontal position, respectively (p = 0.66; two-tailed Mann-Whitney U test).

CONCLUSIONS AND CLINICAL RELEVANCE

Positioning the surgery table in a 15° rostral elevation for dogs anesthetized for elective stifle surgical procedures did not decrease the incidence of GER.

摘要

目的

确定在接受膝关节手术麻醉的犬中，与水平位相比，15°反向特伦德伦堡位是否会降低胃食管反流（GER）的发生率。

研究设计

前瞻性、随机平行臂研究。

动物

共纳入 44 只健康的患犬，对 36 只犬的数据进行了分析。

方法

排除术前需要麻醉下进行放射检查的犬，或有胃肠道症状史或在手术前 1 个月内接受过胃保护剂治疗的犬。麻醉方案标准化，包括氢吗啡酮、右美托咪定、氯胺酮、异丙酚和异氟烷。在入组时，将犬随机分配到 15°反向特伦德伦堡位或水平位进行手术。通过口腔将 6.4Fr（2.13mm）食管 pH 探头置于远端食管，在整个手术过程中进行连续 pH 监测。GER 定义为 pH<4.0（酸性）或>7.5（碱性）超过 30 秒。使用 Fisher 精确检验比较两组中发生 GER 的犬的比例。使用生存曲线和 Gehan-Breslow-Wilcoxon 检验比较反流时间。统计学意义设定为 p<0.05。

结果

36 只犬中有 11 只（30%）发生 GER 事件。反流呈碱性 2 只犬，酸性 9 只犬。反向特伦德伦堡位和水平位的 GER 犬比例分别为 5/18（28%）和 6/18（33%），差异无统计学意义（p>0.99）。在反向特伦德伦堡位和水平位时，犬发生反流的中位（范围）时间分别为 44（23-135）和 44.5（9-56）分钟（p=0.66；双侧曼-惠特尼 U 检验）。