Effect of the reverse Trendelenburg position on the incidence of gastroesophageal reflux in dogs anesthetized for elective stifle surgery |
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| Affiliation: | 1. Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA, USA;2. Institute of Bioinformatics, Franklin College of Arts and Sciences, University of Georgia, Athens, GA, USA;3. Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA, USA;4. Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, MN, USA;1. Dick White Referrals, Six Mile Bottom, Cambridgeshire, UK;2. Pride Veterinary Centre, Derby, UK;3. Department of Veterinary Medicine, University of Cambridge, Cambridge, UK;1. Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, MO, USA;2. Innovative Veterinary Medicine, Ponte Vedra, FL, USA;3. Department of Statistics, College of Arts and Science, University of Missouri, Columbia, MO, USA;4. Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS, USA |
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| Abstract: | ObjectiveTo 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 designProspective, randomized parallel-arm study.AnimalsA total of 44 healthy client-owned dogs were enrolled and data from 36 dogs were analyzed.MethodsDogs 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.ResultsAn 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 relevancePositioning the surgery table in a 15° rostral elevation for dogs anesthetized for elective stifle surgical procedures did not decrease the incidence of GER. |
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| Keywords: | anesthesia complications dogs gastroesophageal reflux perioperative reverse Trendelenburg |
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