Gastric emptying as assessed by paracetamol absorption is normal 32 h after elective abdominal aortic aneurysm surgery (AAA)

Major potential complications following AAA include 1) MODS, possibly related to GI barrier dysfunction [1] and 2) stress ulcers, seen on gastroscopic examination in as many as 80% of patients [2]. Enteral nutrition may prevent both these complications, especially if given early. However patients are often denied this form of treatment because of concerns of delayed gastric emptying. Instead they are subjected to nasogastric (N/G) decompression, shown to be unnecessary and even harmful [3]. We used the paracetamol absorption test to document the presence of intact or abnormal gastric emptying in the immediate postoperative period.

Methods

We studied 13 consecutive patients admitted to the ICU for routine postoperative care following elective AAA. Gastric emptying using the paracetamol absorption test was assessed 6, 18 and 32 h following surgery. The test was considered normal if the area under the concentration curve from 0–60 min (AUC60) after giving 1 mg of paracetamol through the N/G tube was >600 mg/min/1. Other factors noted included i) demographic data;and ii) time to extubation, removal N/G tube and start of enteral feeding.

Results

Patients mean age was 69 ± 12 years; M:F ratio 12:1

1) Results gastric emptying (mean ± SD):

2) Mean time to end-points:

Conclusions

This study showed that 69% of patients hava normal gastric emptying at 18 h and 92% at 32 h following elective AAA. We suggest that unnecessary N/G tubes may be removed and enteral nutrition started to the benefit of the patient 32 h post AAA.

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