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At least 1,153 records · Page 64Linked to original sources
PubMed2001

Gastroesophageal reflux and aspiration of gastric contents in anesthetic practice.

General anesthesia may predispose patients to aspiration of gastroesophageal contents because of depression of protective reflexes during loss of consciousness. In addition, some patients may be at increased risk of pulmonary aspiration because of retention of gastric contents caused by pain, inadequate starvation, or gastrointestinal pathology resulting in reduced gastric emptying and gastroesophageal reflux. Despite increasing knowledge of the problems associated with aspiration, the relatively small incidence and associated mortality rates in the perioperative period do not appear to have changed markedly over the last few decades. In this review article, the physiological factors associated with an increased risk of gastroesophageal reflux and aspiration are considered together with some of the methods that are used to prevent aspiration. In particular, preoperative starvation, the use of drugs designed to increase gastric pH, recent developments in airway devices, and appropriate application of cricoid pressure are critically appraised.

Anesthesia↗
PubMedDate not supplied

[Complications of enteral nutrition at home. Results of a multicentre trial].

AIM: In spite of the increasing number of home enteral nutrition (HEN) patients, only few articles had reported the frequency of complications related to this treatment. Our multicentric study analyzes the HEN complications in relation to access device and time of treatment. METHOD: 92 HEN patients from 8 hospitals were randomly selected. Patients were distributed in relation to the time of treatment and access device (nasogastric tube and percutaneous or surgical gastrostomies). After an educational program, they were filled in an initial questionnaire and repeated it the days 15 and 30. They received a mean of 1650 Kcal of enteral solution. A total of 2760 HEN prospective days were analyzed. RESULTS: In prospective study 42% of patients had some complication (112 episodes). The most frequent were gastrointestinal (55%) and mechanical (29%); 0.16 complications of patient-year were registered. The most common complications were: extraction (15%), constipation (13%), vomiting (12%) and diarrhoea (10%). The gastrostomy group had more gastrointestinal complications. In retrospective evaluation, percutaneous gastrostomy group had the lowest ratio of complications and nasogastric tube group required more tube replacements (4 vs 2) and had 1.96 episodes/patient (percutaneous group 1.85 and surgical gastrostomy 3.1 episodes/patient). CONCLUSION: HEN is safe with low incidence of complications. An adequate educational program is very important and we expect, in the future, to establish an proper National Home Care System.

Adult↗
PubMed2003

Gastric feeding in critically ill children: a randomized controlled trial.

BACKGROUND: Provision of enteral nutrition via the gastric route is a common nursing procedure in pediatric intensive care units. Little research, however, has focused on children's tolerance of different types of gastric feeding regimens. OBJECTIVES: To examine the relationship between 2 gastric feeding regimens, continuous and intermittent, and children's tolerance as measured by the number of stools and prevalences of diarrhea and vomiting. METHODS: A randomized controlled trial was conducted in an Australian pediatric intensive care unit; 45 children were randomly assigned to either the continuous or the intermittent gastric feeding groups. Participants remained in the assigned feeding group for the duration of the study, and values of variables used to monitor patients' tolerance were recorded. RESULTS: Both feeding groups were similar with respect to Pediatric Index Mortality score, age, weight, sex, diagnosis, and use of pharmacological agents known to affect the gastrointestinal tract. Additionally, the 2 groups did not differ in study duration or the daily volume of administered enteral formula per kilogram of body weight. The number of stools per day and the prevalences of diarrhea and vomiting did not differ significantly between the 2 groups. DISCUSSION: Continuous and intermittent gastric feeding regimens have similar outcomes with respect to the number of stools per day and the prevalence of diarrhea and vomiting in pediatric intensive care patients. Further gastric feeding studies and the development of enteral feeding guidelines for critically ill children are needed.

Australia↗
PubMedDate not supplied

What is known about methods of correctly placing gastric tubes in adults and children.

An abdominal radiograph is considered the "gold standard" for determining the position of flexible small-bore nasogastric/orogastric tubes. However, placement must be checked frequently while a tube is in place, and the summative radiation risk of multiple radiographs, as well as their expense, make the development of adequate bedside placement-locating methods imperative. Several methods of detecting tube placement have been investigated in adults, including: aspirating gastric contents and measuring the pH, bilirubin, pepsin, and trypsin levels; examining the visual characteristics of aspirate; placing the proximal end of the tube under water and observing for bubbles in synchrony with expirations; measuring the carbon dioxide level at the proximal end of the nasogastric/orogastric tube; auscultation for a gurgling sound over the epigastrium or left upper quadrant of the abdomen; and measuring the length from the nose/mouth to the proximal end of the tube. Many researchers have already concluded simple auscultation is not a reliable method to assess tube position because injection of air into the tracheobronchial tree or into the pleural space can produce a sound indistinguishable from that produced by injecting air into the gastrointestinal tract. In adults, only pH and bilirubin of aspirate have been shown both to reliably predict tube position and to have inexpensive simple bedside tests. In children, only pH of aspirate has been shown to be reliable. Research on gastric tube placement in children is relatively new because children are challenging to study in that they are considered a vulnerable population. This review of the literature includes results of both adult and pediatric studies. Tube placement error rates varied from 1.9% to 89.5% in adults and between 20.9% and 43.5% in children.

Adult↗
PubMed1978

Site of emetic action of oral copper sulfate in dogs. (I) Thresholds of various portions of gastrointestinal tract to locally applied copper sulfate.

Emetic thresholds to copper sulfate administered into the Pavlov pouch, Forrest pouch, Thiry fistulas of the jejunum and ileum, and duodenal, jejunal and ileal catheters were measured in dogs to conjecture the site of emetic action of copper sulfate. The oral emetic threshold had been measured preoperatively. In the stomach, the pyloric antrum had a high sensitivity, while the corpus had a low sensitivity to the topically applied copper sulfate. In the intestine, the sensitivity was high in the duodenum, whereas a low sensitivity was noted in the jejunum. Almost no sensitivity was observed in the ileum. Thus it would appear that the site of the emetic action of copper sulfate was the pyloric antrum and/or duodenum.

Administration, Oral↗
PubMed1984

The influence of chemical form of zinc on the effects of toxic intraruminal doses of zinc to sheep.

The EDTA, sulphate and oxide compounds of zinc were administered to sheep as a single intraruminal dose (480, 240 or 120 mg Zn per kg body weight) or as thrice-weekly doses (240 mg Zn per kg body weight per dose) for 4 weeks. In the single-dose experiment, serum zinc concentrations rose most rapidly, were highest and fell most rapidly in those animals receiving zinc EDTA. In the sheep receiving the sulphate, serum zinc concentrations were high and stayed high for 2 or 3 days. Zinc oxide caused slight, but prolonged, elevation of serum zinc. High concentrations of zinc were present in urine after administration of zinc EDTA. In the multiple-dose experiments, the sheep dosed with zinc sulphate showed progressively higher elevations of serum zinc (first dose, 5-10 micrograms Zn ml-1; day 13, 30-60 micrograms Zn ml-1) and six of the seven sheep so dosed died before the final dose. At post mortem examination, many of these had lesions of the upper gastrointestinal tract and showed evidence of haemolytic crises. Sheep dosed with zinc oxide also had progressively higher peak serum zinc concentrations. In contrast, the peak serum concentrations for the zinc EDTA-dosed sheep declined as the experiment progressed. No deaths occurred in the sheep dosed with zinc oxide or EDTA. Major pancreatic injury occurred in sheep dosed with the sulphate or oxide, but was only mild in the sheep dosed with the zinc EDTA. Diarrhoea was mild and transitory in the EDTA-dosed sheep, but more severe and persistent in those dosed with the sulphate.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Absorption of an aqueous solution of a new synthetic somatostatin analogue administered to man by gavage.

To determine the local gastrointestinal absorption of a new synthetic somatostatin analogue (SMS 201-995 = Sandostatin), an intestinal tube was passed in eight healthy volunteers and on different days an aqueous solution was administered at four different locations: stomach, proximal duodenum, ligament of Treitz and jejunum. In a follow-up study, an oro-ileal tube was passed in six of the original volunteers and the drug solution was administered in to the terminal ileum. The aqueous solution of SMS was rapidly absorbed from the gastrointestinal tract after local application, and it was well tolerated. Absorption of the drug from the different sites was comparable, although there was a tendency to decreased peptide absorption after ileal administration. Absorption of the drug was quite variable between the subjects and the different locations. The dose-corrected systemic availability relative to subcutaneous administration in another study was 0.28%. However, significant plasma SMS concentrations were achieved, suggesting that oral delivery of the polypeptide may eventually be possible for long-term treatment of a variety of disorders.

Adult↗
PubMed1995

Bioavailability of fluconazole administered via a feeding tube in intensive care unit patients.

Fluconazole, a triazole compound with potent activity against many medically important fungi, undergoes rapid oral absorption, and has been shown in healthy volunteers to exhibit virtually complete bioavailability. The purpose of this study is to evaluate the bioavailability of fluconazole administered via a feeding tube with concomitant enteral feeds in intensive care unit patients. Once prescribed by the attending physician, fluconazole was administered either as an intravenous infusion over 1 h or the tablet was crushed and given via a feeding tube with concomitant enteral feeds. Once blood samples were obtained (not before the fifth dose) of the first regimen, the patient could be switched over to the alternate route and blood samples were again obtained after at least five doses. All patients had normal gastrointestinal motility, normal renal, and hepatic function. Serum concentrations were determined by a validated HPLC method. The area under concentration-time curve (AUC) was calculated using the trapezoidal rule; bioavailability was determined from the ratio of AUC(tube)/AUC(intravenous). The bioavailability for five patients was calculated to be 97.2 +/- 9.8%. Fluconazole retained excellent bioavailability when crushed and administered via a feeding tube with or without concomitant enteral feeding in critically ill patients. This alternative route of administration promotes cost savings and decreases the chance for secondary infection from indwelling intravenous catheters.

Adult↗
PubMed1981

Modes of action of gallic acid in suppressing food intake of rats.

Gallic acid (3,4,5,trihydroxybenzoic acid) is a naturally occurring polyphenol comprising the major hydrolytic product of tannic acid. Gallic acid and tannic acid were previously shown to suppress food intake of animals to a similar extent. However, the mechanism by which this effect takes place has not been previously reported. Reported here is that the effect of gallic acid on food intake is not mediated entirely through taste aversion or through other gastrointestinal factors, since a continuous daily infusion of a gallic acid solution (18 ml; 2%) resulted in a significant reduction of food intake. The catechol moiety of gallic acid plays an important role in its suppression of food intake since administration of tis 4-0 methyl derivative was significantly less effective is suppressing food intake (P less than 0.01). The effectiveness of gallic acid in suppressing food intake diminishes with time, indicating adaptation to the consumption of this polyphenol. Propyl gallate is a more potent suppressor of food intake than gallic acid. Adaptation to the consumption of this polyphenol, it it exists at all, is much slower than with gallic.

Animals↗
PubMed1993

Neurologic disease requiring long-term ventilation. The role of selective decontamination of the digestive tract in preventing nosocomial infection.

STUDY OBJECTIVE: To evaluate the efficacy of the technique of selective decontamination of the digestive tract (SDD) in preventing secondary infections in patients with neurologic diseases requiring intensive care. DESIGN: Randomized, double-blind, placebo-controlled trial using amphotericin B, polymyxin E, and tobramycin applied to the oropharynx and enterally; all patients received intravenous cefotaxime for 72 h. SETTING: Respiratory ICU. PATIENTS: Forty patients with neurologic diseases requiring ventilation for > 48 h and ICU stay > 5 days. Neurologic diagnosis included acute inflammatory demyelinating neuropathy (15), meningoencephalitis (10), status epilepticus (6), tetanus (6), and myasthenia gravis (3). INTERVENTIONS: Microbiologic surveillance samples of oropharyngeal and tracheal secretions, gastric aspirates, stool, urine, and any other potentially infected sites were taken at the time of ICU admission and twice weekly thereafter until 3 days after discharge from the unit. The SDD was applied every 6 h to the oropharynx and enterally. MEASUREMENTS AND RESULTS: Effective decontamination of the gastrointestinal tract was achieved in the patients receiving the active regimen; however, there was no reduction in the incidence of infections (11 in the active group vs 10 in placebo), and duration of ICU stay (30.1 +/- 22.5 vs 20.6 +/- 17.7 days) and hospital stay (49.3 +/- 31.9 vs 40 +/- 33.4 days) were unaffected as was the mortality (15 percent vs 15 percent). CONCLUSIONS: SDD did not reduce the incidence of secondary infection in patients with neurologic disease, nor did it affect morbidity or mortality; however, it adds considerably to the cost of patient care.

Administration, Oral↗
PubMed1982

Pancreatic exocrine function in rosacea.

As some rosacea patients complain of gastrointestinal troubles and the administration of pancreatic extracts ameliorates both dyspepsia and skin lesions, the pancreatic exocrine function in 21 subjects affected with rosacea has been investigated by means of the secretin-cerulein infusion test. 21 healthy controls have been studied for comparison. No difference was found between rosacea and control subjects for flow rate, bicarbonate and chymotrypsin concentration and output, while lipase concentration and output was significantly lower in rosacea patients, with a decrease ranging from 18.5 to 66% of normal values. Therefore, a deficient lipase secretion could be responsible, at least partly, for the clinical manifestations of rosacea.

Adult↗
PubMed2003

Unusual complications of long-term percutaneous gastrostomy tubes.

Percutaneous endoscopic gastrostomy (PEG) has been popular since it was introduced in 1980. Gastrostomy tubes left in place for long periods often result in unusual complications. Complications may also result from simply replacing a long-term indwelling tube. Five patients who had gastrostomy tubes in place for as long as 4 years are presented and their complications reviewed. Various methods used in treating these complications are discussed, and suggestions for their prevention are given. Gastrointestinal erosion and jejunal perforation following migration of the gastrostomy tube, persistent abdominal wall sinus tracts, and separation of the flange head with small bowel obstruction were encountered. Reinsertion of a gastrostomy tube through a tract prior to adequate maturation was also noted to lead to complications. Complications may result from gastrostomy tubes left in place for extended periods of time and during replacement procedures. Awareness of such complications along with education of caregivers and timely intervention by the endoscopist may prevent such occurrences. In some cases one can only hope to minimize morbidity.

Adolescent↗
PubMed1995

Bowel obstruction in home-care cancer patients: 4 years experience.

Conservative management of bowel obstruction in advanced cancer patients has been recognized as efficacious in controlling distressing symptoms such as nausea, vomiting and pain. A retrospective analysis of prevalence, treatment and outcome was performed. A group of 25 patients with signs of bowel obstruction were studied from 1001 consecutive patients receiving palliative care at home. A score for total distress was calculated to assess the gastrointestinal symptoms at diagnosis, after 1 week of treatment and 1 day before death. The mean survival was 19 days. Six patients were admitted to hospital, 3 of whom underwent surgery and died in the immediate postoperative period. The patients diagnosed in hospital and discharged received a nasogastric tube (7 cases) and a central venous line. The nasogastric tube was removed after gastrointestinal secretions had been controlled by a combination of drugs, and parenteral nutrition or hydration, mainly started in hospital, was discontinued only a few days before death (13 cases, mean duration 19 days). The distress symptom score was statistically reduced after 1 week of treatment and on the day before death when compared to the referral time. The most frequent combination of drugs was octreotide, haloperidol and low doses of morphine. A subcutaneous route was preferred for administering the drugs. Utilization of a wide range of drugs permits good symptom control for bowel obstruction in patients followed at home.

Abdominal Neoplasms↗
PubMed2006

An overview of tube feeding: from ancient times to the future.

The history of enteral feeding goes back about 3,500 years to the ancient Greeks and Egyptians, who infused nutrient solutions into the rectum to treat various bowel disorders. Over the centuries, experimentation and research have contributed to a greater understanding of nutrient requirements; methods to more accurately access the gastrointestinal tract; development of new materials to use in equipment, tubes, and containers; and the digestion, absorption, and use of macro- and micronutrients. It is notable that while advances were made in one area, progress was being made in another. For example, while enteral access and feeding techniques were being developed, essential amino acids were identified. When new information came together, rapid changes opened up the applications for enteral feeding in new directions, sometimes in unexpected ways such as diets designed for the space program, leading to the use of elemental diets as a therapeutic modality.

Enteral Nutrition↗
PubMed2001

Naso-jejunal feeding in allogeneic bone marrow transplant recipients: results of a pilot study.

Patients undergoing allogeneic bone marrow transplants (BMT) are often malnourished prior to commencing the procedure. They face intensive treatment with often marked nutritional consequences. There is no consensus on the optimal nutritional management of these patients. Elective parenteral nutrition (PN), beginning pre-transplant irrespective of the patients nutritional status, or the use of "salvage" PN, beginning during the post-transplant period if the patient fails to maintain nutritional status with oral diet, have been used. Enteral nutrition may benefit the patient by maintaining nutritional support throughout the transplant period, avoiding the complications and expense of PN and possibly, by using specific diets, protecting the gastrointestinal tract from the effects of chemoradiation. However, naso-gastric feeding during a transplant is not without risks, including the safe insertion of a tube in patients with mucositis and pan-cytopenias, tube displacement by vomiting and aspiration from gastro-oesophageal reflux. An alternative approach is to use naso-jejunal (NJ) feeding tubes which are associated with less risk of loss due to vomiting and less risk of aspiration. We report a pilot study of 15 allogeneic BMT patients who had elective NJ feeding initiated before conditioning therapy irrespective of perceived nutritional compromise. This was well tolerated and feasible with a motivated nutritional team.

Bone Marrow Transplantation↗
PubMed1991

Absorption and disposition of epithiosteroids in rats (2): Avoidance of first-pass metabolism of mepitiostane by lymphatic absorption.

1. Absorption of mepitiostane (MP) from the gastrointestinal tract was examined using thoracic duct-cannulated rats. 2. When 14C-MP was administered into the small intestine, 34% of the radioactivity was recovered in the 6-h thoracic duct lymph. More than 90% of this radioactivity was due to unchanged MP and most of the MP in the lymph was carried in the lipid core of the chylomicrons and VLDL. 3. Radioactivity in the portal blood was extensively extracted by the liver and excreted into bile as polar metabolites. Thus, most unchanged MP which entered the systemic circulation following oral administration was drug absorbed via the intestinal lymphatics. 4. MP avoids the first-pass effect by lymphatic adsorption.

Androstanols↗
PubMed1988

Percutaneous endoscopic gastrostomy.

Percutaneous endoscopic gastrostomy has been shown by many investigators to be a safe, rapid means of gaining access to the gastrointestinal tract. Over a 3 1/2 year period, 155 percutaneous endoscopic gastrostomies were performed. All of the patients had an inability to nourish themselves orally. The technique described by Ponsky et al was used. Preoperative antibiotics were administered to 108 patients, and most of the procedures were performed under local anesthesia. Many of the procedures were performed in association with tracheostomies. There were 17 complications (11 percent), including 2 deaths (1 percent). Comparison of percutaneous endoscopic gastrostomy to operative gastrostomy revealed percutaneous endoscopic gastrostomy to be superior. We believe that percutaneous endoscopic gastrostomy should be considered the procedure of choice for tube gastrostomy.

Adolescent↗
PubMed2004

Preventing and managing complications of enteral nutritional support.

Complications of enteral nutritional support include mechanical problems related to the feeding device, gastrointestinal side effects, metabolic disturbances, and infectious complications. Although the sickest patients are often the ones that we feel will most likely benefit from nutritional support, they are generally more challenging to feed and least likely to tolerate complications arising from assisted feeding. Many of the problems that can occur with enteral nutritional support can be anticipated, which may allow them to be avoided or possibly aid in early detection and thereby minimize consequences to the patient. Therefore, knowledge of the types of complications that can occur with enteral nutritional support will aid in the process of deciding whether and how a patient should receive assisted feeding, and what parameters to monitor while a patient is receiving nutritional support.

Animals↗