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CASE REPORT
Year : 2007  |  Volume : 51  |  Issue : 1  |  Page : 37-38 Table of Contents     

Aerophagia an unusual cause of near fatal ventilatory insufficiency


M.D., D.N.B., Consultant Anaesthetist, 44, Beldih Lake Flats, Dhatkidih, Jamshedpur-831001 Jharkhand, India

Date of Web Publication20-Mar-2010

Correspondence Address:
Ashok Jadon
M.D., D.N.B., Consultant Anaesthetist, 44, Beldih Lake Flats, Dhatkidih, Jamshedpur-831001 Jharkhand
India
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Source of Support: None, Conflict of Interest: None


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Aerophagia or excessive ingestion of air is commonly seen in psychiatric children. Aerophagia though rarely occurs during anaesthesia has been reported which ketamine anaesthesia mainly during recovery period. Early recognition and management of this condition is warranted as this may lead to serious, and some time fatal ventilatory inadequacy due to acute gastric dilatation

Keywords: Aerophagia, Ketamine Anaesthesia, Ventilatory insufficiency


How to cite this article:
Jadon A. Aerophagia an unusual cause of near fatal ventilatory insufficiency. Indian J Anaesth 2007;51:37-8

How to cite this URL:
Jadon A. Aerophagia an unusual cause of near fatal ventilatory insufficiency. Indian J Anaesth [serial online] 2007 [cited 2020 Sep 22];51:37-8. Available from: http://www.ijaweb.org/text.asp?2007/51/1/37/61113


   Introduction Top


Aerophagia represents a functional gastrointestinal disorder seen in children who have pathologic childhood [1] or they are mentally challenged. [2] It is estimated that 70% of the gastrointestinal gas is swallowed, 20% is caused by diffusion of gases from the blood, and 7% to 10% is the result of bacterial decomposition. [3]

Aerophagia during anaesthesia is rarely reported, however aerophagia during ketamine anaesthesia leading to ventilatory insufficiency have recently been reported in children [4] as well as in animals. [5]




   Case report Top


A 26 months old 12 kg male child was operated for phimosis and circumcision was done. Preoperative assessment did not show any physical or biochemical abnormality. Child had upper respiratory tract infection 3 weeks before scheduled operation date which was treated and cured with oral antibiotics and antihistamines. Induction was done with intravenous ketamine 20 mg, atropine 0.2 mg and midazolam 0.5 mg. Caudal block was given in left lateral position with 10 ml of 0.25% preservative free bupivacaine under aspectic conditions. After 10 minutes of induction additional dose of 20 mg of intravenous ketamine was given and operation was started. Intraoperative monitoring was done with pulse oxymeter and NIBP. Operation was uneventful except child was having grunting sound during operation and some secretion in the throat which required suction once. Duration of surgery was 25 minutes. SaO 2 was maintained between 94% - 98% but it was rapidly decreasing towards the end of operation (88%). Oxygen supplementation started via mask and Ayer's T piece (Jackson Rees modification) which did not improve the saturation. Covering drapes were removed, then it was noticed that abdomen was grossly distended mainly in epigastric area, child was almost apnoeic as there was hardly any tidal exchange. Ryle's tube was inserted immediately and large amount of air was sucked out. Saturation and breathing became normal soon after expulsion of air. Ryle's tube was removed and child again developed sever distension of abdomen and inadequate breathing. Child was still having salivation and grunting which actually was sound of swallowing air. Intravenous atropine 0.1 mg was given Ryle's tube was again inserted and left in stomach which showed continous drainage of air for next 15 minutes after which child was awake, and air swallowing was stopped. Ryle's tube was removed and after that postoperative period was uneventful. On enquiry from parents child never had aerophagia before.


   Discussion Top


In recent animal study it was found that dissociative anaesthetic drugs (similar to ketamine) causes aerophagia due to central nervous system stimulation and can also leads to gastric distension.[5] Gastric decompression by nasogastric tube has been necessary in a few patients in whom respiration was hindered by the extreme elevation of the diaphragm. [6] We used atropine to reduce secretions during recovery which might have shortened the duration of aerophagia as low dose of propofol and atropine has been given to control the signs and aerophagia. [5] The implication of prompt recognition of problem is that other than acute respiratory insufficiency the massive distension of the bowel may lead to ileus, volvulus, and necrosis. [7],[8] Grunting during ketamine anaesthesia should be looked for associated aerophagia as in our case the sound of air swallowing was misjudged as grunting sound which may occur during ketamine anaesthesia.


   Conclusion Top


A better recognition of this condition might contribute towards earlier diagnosis.

 
   References Top

1.Rosenbach Y, Zahavi I, Nitzan M, Dinari G. Pathologic childhood aerophagy : an under - diagnosed entity. Eur J Pediatrics 1988; 147(4): 422-23.  Back to cited text no. 1      
2.Lecine T, Michaud L, Gottrand F et al. Children who swallow air. Arch Pediatrics 1998; 5(11): 1224-28.  Back to cited text no. 2      
3.Stone RT, Morgan MC. Aerophagia in children. Am Fam Physician 1971; 3: 94-95.  Back to cited text no. 3      
4.Lalwani K. Aerophagia and anesthesia: an unusual cause of ventilatory insufficiency in a neonate. Paediatric Anaesth 2005; 15(10): 897-99.  Back to cited text no. 4      
5.Savas I et al. Risk of bloat during recovery from dissociative anaesthesia. Veterinary Record 2001; 149: 20-21.  Back to cited text no. 5      
6.Gauderer MW, Halpin Jr TC, Izant Jr RJ. Pathologic childhood aerophagia: a recognizable clinical entity. J Pediatr Surg 1981; 16: 301-05.  Back to cited text no. 6      
7.Vander Kolk MB, Bender MH, Goris RJ. Acute abdomen in mentally retarded patients; role of aerophagia: report of nine cases. Eur J Surg 1999; 165: 507-11.  Back to cited text no. 7      
8.Trillis Jr F Gauderer MWL, Ponsky JL et al. Transverse colon volvulus in a child with pathologic aerophagia. J Pediatr Surg 1986; 21: 966-68.  Back to cited text no. 8      




 

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  In this article
    Abstract
    Introduction
    Case report
    Discussion
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    References

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