QUESTION:

"Acid reflux is increasingly common in our patient population. Many patients have mild symptoms or in fact no symptoms at all while taking acid suppressive therapy. Is there evidence to suggest a higher risk of aspiration in these patients? What about the patient with an asymptomatic hiatal hernia? And is acid reflux a contraindication to the use of the laryngeal mask airway?"

-- Anonymous

NEW REPLY:

"I agree that the increased "prevalence" is due to awareness, partly caused by marketing by drug companies."

"It occurs to me that the use of other supraglottic airways that have greater "occlusivity" as evidenced by effective airway pressures before "leak" is noted and ex vivo gastric pressure testing might be more wise. The classic LMA is convenient, but more limited in that regard."

-- From Charles B. Watson, MD, FCCM, Bridgeport, CT

?? - - LAST MONTH'S QUESTION - - ?? - TOP

"What is the minimum time we need to wait before delivering anesthesia to pediatric patients after upper respiratory infections?"

-- Anonymous

REPLY:

"I recommend a month to the surgeons. However, I have broken my own rule, especially when other factors (social, repetitive illness, urgency of case) intervene. The data, as far as I know, say six weeks. However, I find that a very hard sell."

-- From Phil Morgan, MD, Cleveland, OH

?? -- THIS MONTH'S QUESTION -- ?? - TOP

"I work in an ambulatory facility which occasionally has “special surgical days”. On those days, three to five times the regular daily number of surgeries are done in order to decrease the waiting list of patients (pediatrics, general surgery, and ENT). Does SAMBA have any guidelines or suggestions for this high-volume day?"

-- From Celina Beatriz Contreras, MD, Merida, Venezuela

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