Gastric contents in pediatric patients following bone marrow transplantation

Area of Science:

• Anesthesiology
• Gastroenterology
• Pediatric Hematology/Oncology

Background:

• Graft versus host disease (GVHD) of the gut may delay gastric emptying, increasing aspiration risk during anesthesia.
• Limited data exists on airway management guidance for pediatric bone marrow or stem cell transplantation (BMT) patients with suspected GVHD undergoing procedures.
• This review aimed to assess gastric contents in pediatric BMT patients to inform anesthesiologists' airway management decisions.

Purpose of the Study:

• To evaluate gastric content volume and pH in pediatric bone marrow or stem cell transplantation (BMT) patients.
• To provide anesthesiologists with data to guide airway management decisions for BMT patients, particularly those with suspected Graft versus host disease (GVHD).

Main Methods:

• Retrospective chart review of patients aged 19 years or younger undergoing esophagogastroduodenoscopy (EGD) between 2004 and 2006.
• Measurement of gastric content volume and pH, along with underlying disease state and treatment.
• Comparison of BMT patients with suspected GVHD to non-transplant patients with other gastrointestinal conditions.

Main Results:

• Data from 77 post-BMT patients (40 with GVHD, 37 without) and 144 non-BMT patients were analyzed.
• Overall gastric content volume was not higher in BMT patients compared to non-BMT patients.
• GVHD-positive BMT patients showed potentially elevated gastric content volume and statistically significantly higher gastric pH compared to GVHD-negative BMT patients and non-BMT patients.

Conclusions:

• While GVHD may slightly increase aspiration risk due to gastric volume, higher gastric pH in BMT patients might mitigate pneumonitis severity.
• Anesthesiologists should consider these findings when managing airways for pediatric BMT patients undergoing EGD.
• Further research may be warranted to refine airway management protocols for this specific population.