Effect of pre-anesthetic meperidine on gastro-esophageal reflux in anesthetized dogs

Meperidine has been shown to decrease lower esophageal sphincter tone in monkeys and people, to have little effect in cats, and to physically increase it in dogs. We hypothesized that administration of meperidine to dogs before anesthesia would decrease the probability of GER during the subsequent anesthetic. In this randomized, prospective clinical trial we aimed to determine the incidence of GER in dogs undergoing elective orthopedic surgery and receiving either meperidine or morphine prior to anesthesia. Dogs were admitted to the study, if they were healthy, with no history of vomiting or dysphagia. Dogs were fasted overnight. Dogs were received either morphine (0.66 mg kg^–1 IM) or meperidine (8.8 mg kg^–1 IM) with acepromazine. Anesthesia in all dogs included thiopental and isoflurane in oxygen. To measure esophageal pH a sensor-tipped catheter was placed with the tip 5–7 cm cranial to the lower esophageal sphincter, and connected to a computer for continual data collection. Dogs were observed for vomiting after pre-medication, and the pH of any fluid running from the mouth or nose during anesthesia was measured. Gastro-esophageal reflux was defined as a decrease in esophageal pH below 4 or an increase above 7.5 for greater than 15 seconds. One-way anova was used to test significance of differences between groups in parametric variables. Fisher's Exact test was used to test significance of differences in incidence between groups. In dogs receiving meperidine the incidence of vomiting was 0, and of GER was 31% (4/13), compared to 60% (6/10) and 60% (6/10), respectively in dogs receiving morphine. In this preliminary study, the administration of pre-anesthetic meperidine was associated with a 29% reduction in the absolute risk of GER compared to morphine.