The 60% Problem — Managing Gastroesophageal Reflux Under Anesthesia

Have you ever pushed the induction agent and watched your patient's stomach do something alarming before the tube was even in? Studies report gastroesophageal reflux in up to 60% of anesthetized patients — many episodes silent enough that you never see a drop. In this episode, Tracey, Travis, and Maryann share the cases that changed how they practice and the protocols that keep their patients safer from induction through recovery.

From ketamine-assisted NG tube placement and higher-rate metoclopramide CRIs to the Poole suction tip and updated AAHA fasting guidelines — plus a veterinary history detour into an 1890 textbook on equine diabetes that's surprisingly accurate.

Key Topics Discussed

• The Real Prevalence of GER: Up to 60% of anesthetized patients may experience reflux — a 2024 study (Blignaut et al.) found 57% via endoscopy. Breed, sex, and age are not significant risk factors.
• Risk Factors That Matter: Late pregnancy, large intra-abdominal masses, delayed gastric emptying, and surgical manipulation all increase GER risk. One study found 30% reflux in routine stifle surgery dogs.
• Fasting and Water Protocols: AAHA recommends no more than 4–6 hours of fasting for healthy adults. Withholding water overnight increases dehydration without reducing reflux risk.
• Pre-Induction Techniques: A ketamine-based protocol allows NG tube placement while preserving lower esophageal sphincter tone — a game-changer for foreign body and full-stomach patients.
• Metoclopramide and Acid Reducers: Standard CRI rates don't cut it; higher-rate infusions benefit LES tone and gastric emptying. Two doses of omeprazole (night before + morning of) for high-risk cases.
• The Poole Suction Technique: Insert along the left side of the ET tube into the proximal esophagus to suction fluid. Have it ready before you need it.
• Recovery That Protects: Sternal recumbency, laryngoscope check before extubation, no abdomen pressure, and waiting for the swallow reflex before deflating the cuff.

Questions to Think About While You Listen:

1. Do your highest-risk cases have a specific pre-induction reflux protocol, or are you responding after the fact?
2. How does your current fasting protocol compare to the updated AAHA guidelines?
3. Is your portable suction unit at the induction station right now, with everything attached and ready?

Team Challenge: Suction Station Audit — Go find your portable suction unit. Is it at your induction station with a hose and tip attached? If not, that's this week's mission.

#CARESaction: After a hard case, check in with a colleague. Not to debrief — just to listen.

Links:https://www.aaha.org (AAHA Fasting Guidelines)https://pubmed.ncbi.nlm.nih.gov (Hickey et al. — GER and Reversed Trendelenburg in Dogs)https://www.sciencedirect.com/science/article/pii/S1467298724001454 (Blignaut et al. 2024 — GOR detection methods in anesthetized dogs)

The views shared are for educational purposes only and do not replace veterinarian approval or institutional protocols. Every patient is unique.

Thank you for listening! Find us @CARESVetMed or email hello@caresvetmed.com.

Take care, friends!