Effect of the duration of food withholding prior to anesthesia on gastroesophageal reflux and regurgitation in healthy dogs undergoing elective orthopedic surgery

Sivert Viskjer Evidensia Strömsholm Referral Small Animal Hospital, Djursjukhusvägen 11, 734 94 Strömsholm, Sweden.

Search for other papers by Sivert Viskjer in
Current site
Google Scholar
PubMed
Close
 DVM
and
Lennart Sjöström Evidensia Strömsholm Referral Small Animal Hospital, Djursjukhusvägen 11, 734 94 Strömsholm, Sweden.

Search for other papers by Lennart Sjöström in
Current site
Google Scholar
PubMed
Close
 DVM

Abstract

OBJECTIVE To compare the incidence of and risk factors for gastroesophageal reflux (GER) and regurgitation associated with preanesthetic food withholding for periods of 18 hours (overnight) and 3 hours in healthy dogs undergoing elective orthopedic surgery.

ANIMALS 82 healthy (American Society of Anesthesiologists physical status classification I or II) client-owned dogs.

PROCEDURES Food was withheld for 18 hours (18-hour group [n = 41]) or each dog was allowed to consume half its daily ration of canned food approximately 3 hours (3-hour group [n = 41]) prior to induction of anesthesia. In each anesthetized dog, a pH catheter was introduced through the oropharynx into the distal portion of the esophagus; the pH was continuously recorded throughout the period of anesthesia. Gastroesophageal reflux was defined as pH < 4.0.

RESULTS Gastroesophageal reflux was significantly associated with age, dorsal recumbency, and duration of preanesthetic food withholding. Regurgitation was significantly associated with duration of GER and duration of preanesthetic food withholding. During anesthesia, 25 (61%) dogs in the 3-hour group had GER and 12 (48%) of those dogs regurgitated gastric content; 18 (43.9%) dogs in the 18-hour group had GER and 2 (11.1%) of those dogs regurgitated gastric content. The mean lowest pH measured in the refluxate in the 3-hour group (2.3) was significantly greater than that in the 18-hour group (1.3).

CONCLUSIONS AND CLINICAL RELEVANCE Among the study dogs undergoing orthopedic surgery, consumption of a light meal 3 hours prior to anesthesia was associated with significantly greater odds of reflux and regurgitation, compared with overnight food withholding.

Abstract

OBJECTIVE To compare the incidence of and risk factors for gastroesophageal reflux (GER) and regurgitation associated with preanesthetic food withholding for periods of 18 hours (overnight) and 3 hours in healthy dogs undergoing elective orthopedic surgery.

ANIMALS 82 healthy (American Society of Anesthesiologists physical status classification I or II) client-owned dogs.

PROCEDURES Food was withheld for 18 hours (18-hour group [n = 41]) or each dog was allowed to consume half its daily ration of canned food approximately 3 hours (3-hour group [n = 41]) prior to induction of anesthesia. In each anesthetized dog, a pH catheter was introduced through the oropharynx into the distal portion of the esophagus; the pH was continuously recorded throughout the period of anesthesia. Gastroesophageal reflux was defined as pH < 4.0.

RESULTS Gastroesophageal reflux was significantly associated with age, dorsal recumbency, and duration of preanesthetic food withholding. Regurgitation was significantly associated with duration of GER and duration of preanesthetic food withholding. During anesthesia, 25 (61%) dogs in the 3-hour group had GER and 12 (48%) of those dogs regurgitated gastric content; 18 (43.9%) dogs in the 18-hour group had GER and 2 (11.1%) of those dogs regurgitated gastric content. The mean lowest pH measured in the refluxate in the 3-hour group (2.3) was significantly greater than that in the 18-hour group (1.3).

CONCLUSIONS AND CLINICAL RELEVANCE Among the study dogs undergoing orthopedic surgery, consumption of a light meal 3 hours prior to anesthesia was associated with significantly greater odds of reflux and regurgitation, compared with overnight food withholding.

Contributor Notes

Address correspondence to Dr. Viskjer (sivert.viskjer@evidensia.se).
  • 1. Anagnostou TL, Savvas I, Kazakos GM, et al. Effect of endogenous progesteron and oestradiol-17β on the incidence of gastro-oesophageal reflux and on the barrier pressure during general anaesthesia in the female dog. Vet Anaesth Analg 2009; 36: 308318.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2. Favarato ES, de Sousa MV, dos Santos Costa PR, et al. Ambulatory esophageal pHmetry in healthy dogs with and without the influence of general anesthesia. Vet Res Commun 2011; 35: 271282.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3. Panti A, Bennett RC, Corletto F, et al. The effect of omeprazole on oesophageal pH in dogs during anaesthesia. J Small Anim Pract 2009; 50: 540544.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4. Wilson DV, Evans T, Miller R. Effects of preanesthetic administration of morphine on gastroesophageal reflux and regurgitation during anesthesia in dogs. Am J Vet Res 2005; 66: 386390.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5. Galatos AD, Raptopoulos D. Gastro-oesophageal reflux during anaesthesia in the dog: the effect of age, positioning and type of surgical procedure. Vet Rec 1995; 137: 513516.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6. Favarato ES, Souza MV, Costa PRS, et al. Evaluation of metoclopramide and ranitidine on the prevention of gastroesophageal reflux episodes in anesthetized dogs. Res Vet Sci 2012; 93: 466467.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7. Galatos AD, Raptopoulos D. Gastro-oesophageal reflux during anaesthesia in the dog: the effect of preoperative fasting time and premedication. Vet Rec 1995; 137: 479483.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8. Savvas I, Rallis T, Raptopoulos D. The effect of pre-anaesthetic fasting time and type of food on gastric content volume and acidity in dogs. Vet Anaesth Analg 2009; 36: 539546.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9. Pratschke KM, Bellenger CR, McAllister H, et al. Barrier pressure at the gastroesophageal junction in anesthetized dogs. Am J Vet Res 2001; 62: 10681072.

  • 10. Wilson DV, Boruta DT, Evans AT. Influence of halothane, isoflurane, and sevoflurane on gastroesophageal reflux during anesthesia in dogs. Am J Vet Res 2006; 67: 18211825.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11. Wilson DV, Evans AT, Mauer WA. Influence of metoclopramide on gastroesophageal reflux in anesthetized dogs. Am J Vet Res 2006; 67: 2631.

  • 12. Raptopoulos D, Galatos AD. Gastro-oesophageal reflux during anaesthesia induced with either thiopentone or propofol in the dog. Vet Anaesth Analg 1997; 24: 2022.

    • Search Google Scholar
    • Export Citation
  • 13. Strombeck DR, Harrold D. Effects of atropine, meperidine, and xylazine on gastroesophageal sphincter pressure in the dog. Am J Vet Res 1985; 46: 963965.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14. Waterman AE, Hashim MA. Effects of thiopentone and propofol on lower oesophageal sphincter and barrier pressure in the dog. J Small Anim Pract 1992; 33: 530533.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15. Waterman AE, Hashim MA, Pearson H. Effect of body position on oesophageal and gastric pressures in the anaesthetised dog. J Small Anim Pract 1995; 36: 196200.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16. Schindlbeck NE, Ippisch H, Klauser AG, et al. Which pH threshold is best in esophageal pH monitoring? Am J Gastroenterol 1991; 86: 11381141.

    • Search Google Scholar
    • Export Citation
  • 17. Harai BH, Johnson SE, Sherding RG. Endoscopically guided balloon dilatation of benign esophageal strictures in 6 cats and 7 dogs. J Vet Intern Med 1995; 9: 332335.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18. Bissett SA, Davis J, Subler K, et al. Risk factors and outcome of bougienage for treatment of benign esophageal strictures in dogs and cats: 28 cases (1995–2004). J Am Vet Med Assoc 2009;235: 844850.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19. Leib MS, Dinnel H, Ward DL, et al. Endoscopic balloon dilatation of benign esophageal strictures in dogs and cats. J Vet Intern Med 2001; 15: 547552.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20. Weyrauch EA, Willard MD. Esophagitis and benign esophageal strictures. Compend Contin Educ Pract Vet 1998; 20: 203211.

  • 21. Pratschke KM, Fitzpatrick E, Campion D, et al. Topography of the gastro-oesophageal junction in the dog revisited: possible clinical implications. Res Vet Sci 2004; 76: 171177.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22. Rådmark T, Pettersson GB. The contribution of the diaphragm and an intrinsic sphincter to the gastroesophageal antireflux barrier. An experimental study in the dog. Scand J Gastroenterol 1989; 24: 8594.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23. Vantrappen G, Tack J, Huyberechts G, et al. Studies on relationship between esophageal acid exposure, mucosal lesions and heartburn using an acid exposure sensor. Scand J Gastroenterol 2002; 37: 12531258.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24. Szentpali K, Erös G, Kaszaki J, et al. Microcirculatory changes in the canine oesophageal mucosa during experimental reflux oesophagitis: comparison of the effects of acid and bile. Scand J Gastroenterol 2003; 38: 10161022.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25. Tarnawski AS, Ahluwalia A. Molecular mechanisms of epithelial regeneration and neovascularization during healing of gastric and esophageal ulcers. Curr Med Chem 2012; 19: 1627.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26. Glazer A, Walters P. Esophagitis and esophageal strictures. Compend Contin Educ Vet 2008; 30: 281292.

  • 27. Maltby JR. Fasting from midnight. The history behind the dogma. Best Pract Res Clin Anaesthesiol 2006; 20: 363378.

  • 28. Hausel J, Nygren J, Lagerkranser M, et al. A carbohydrate-rich drink reduces preoperative discomfort in elective surgery patients. Anesth Analg 2001; 93: 13441350.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29. Thorell A, Loftenius A, Andersson B, et al. Postoperative insulin resistance and circulating concentrations of stress hormones and cytokines. Clin Nutr 1996; 15: 7579.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30. Soop M, Nygren J, Thorell A, et al. Preoperative oral carbohydrate treatment attenuates endogenous glucose release 3 days after surgery. Clin Nutr 2004; 23: 733741.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31. Poncet CM, Dupre GP, Freiche VG, et al. Prevalence of gastrointestinal tract lesions in 73 brachycephalic dogs with upper respiratory syndrome. J Small Anim Pract 2005; 46: 273279.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32. O'Toole E, Miller CW, Wilson BA, et al. Comparison of the standard predictive equation for calculation of resting energy expenditure with indirect calorimetry in hospitalized and healthy dogs. J Am Vet Med Assoc 2004; 225: 5864.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33. Kwiatek MA, Menne D, Steingoetter A, et al. Effect of meal volume and calory load on postprandial gastric function and emptying: studies under physiological conditions by combined fiber-optic pressure measurement and MRI. Am J Physiol Gastrointest Liver Physiol 2009; 297: G894G901.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34. Wood JD, Galligan JJ. Function of opioids in the enteric nervous system. Neurogastroenterol Motil 2004; 16: 1728.

  • 35. Anggiansah A, Sumboonnanonda K, Wang J, et al. Significantly reduced acid detection at 10 centimeters compared to 5 centimeters above lower esophageal sphincter in patients with acid reflux. Am J Gastroenterol 1993; 88: 842846.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36. Mattox HE, Richter JE, Sinclair JW, et al. Gastroesophageal pH step-up inaccurately locates proximal border of lower esophageal sphincter. Dig Dis Sci 1992; 37: 11851191.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37. Kahrilas PJ, Quigley EM. Clinical esophageal pH recording: a technical review for practice guideline development. Gastroenterology 1996; 110: 19821996.

  • 38. Aksglæde K, Funch-Jensen P, Thommesen P. Intra-esophageal pH probe movement during eating and talking. Acta Radiol 2003; 44: 131135.

  • 39. Waterman AE, Hashim MA. Measurement of the length and position of the lower oesophageal sphincter by correlation of external measurements and radiographic estimations in dogs. Vet Rec 1991; 129: 261264.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Advertisement