Gastroesophageal reflux (GER) is characterized by troublesome and frequent symptoms of heartburn or regurgitation. It has an adverse impact on quality of life and is tied to poor mental well-being. The risk factors for the incidence and extent of GER in patients undergoing general anesthesia are not clearly understood.1 Aspiration of acid into the lungs is a complication of general anesthesia. In this regard, premedication with ranitidine has been found to be effective in reducing the volume of gastric secretions and increasing gastric pH.2

A retrospective study was conducted to determine the independent risk factors for the incidence and extent of GER during general anesthesia.

The study included 601 adult patients who received general anesthesia intubation or laryngeal mask surgery from July 2016 through January 2019 in Shanghai General Hospital of Nanjing Medical University. The characteristics of patients and the incidence or extent of GER were noted. Using multivariate logistic regression, investigators assessed the potential risk factors for the incidence of GER, and using multivariate linear regression, the risk factors for the extent of GER were assessed.

Of the patients included in the study, 82 had GER and 519 patients were without GER. There were significant differences between GER and non-GER patients for pharyngitis, history of GER, history of asthma, other digestive tract diseases, and the use of sufentanil (P < 0.05). On the other hand, there appeared to be no significant differences between the groups with regard to sex, age, type of surgery, operative time, intraoperative blood loss, body mass index, hypertension, diabetes mellitus, smoking status, alcohol consumption, psychiatric history, history of respiratory infection, history of surgery, the use of lidocaine, propofol, palliative strategies, or rocuronium bromide, state anxiety inventory, trait anxiety inventory, and self-rating depression scale (P > 0.05).  

Multivariate logistic regression analysis suggested that female sex [odds ratio (OR): 2.702; P = 0.023], advanced age (OR: 1.031; P = 0.009), pharyngitis (OR: 31.388; P < 0.001), and history of GER (OR: 11.925; P < 0.001) were tied to an increased risk of GER. The use of propofol appeared to be protective against the risk of GER (OR: 0.942; 95%CI: 0.892-0.994; P = 0.031). Age (P = 0.004), operative time (P < 0.001), pharyngitis (P < 0.001), history of GER (P = 0.024), and hypertension (P = 0.017), had a significant correlation with GER time.

The study identified the risk factors for GER in patients undergoing general anesthesia, which included female sex, advanced age, history of GER, and pharyngitis.

References

1. Zhao X, Li ST, Chen LH, et al. Identification of independent risk factors for intraoperative gastroesophageal reflux in adult patients undergoing general anesthesia. World J Clin Cases. 2021 Dec 16;9(35):10861-10870.
2. Clark K, Lam LT, Gibson S, Currow D. The effect of ranitidine versus proton pump inhibitors on gastric secretions: a meta-analysis of randomised control trials. Anaesthesia 2009;64:652-7.