[size=20px]After performing an esophageal atresia repair the patient is doing well but an esophagram on postoperative day seven identifies an anastomotic leak adequately drained with a chest tube. Which of the following medications has been shown to slow or stop the esophageal leak?

 

 

A metoclopramide / Reglan™

 

B esomeprazole / Nexium™

 

C guaifenesin / Mucinex™

 

D acetylcysteine / Mucomyst™

 

E glycopyrrolate / Robinul™

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E

E glycopyrrolate

as it reduces the saliva production and thus enhances the closure of the leak

e

Glycopyrrolate but it does thicken the saliva and secretions so you have to be a bit careful with patients who are ventilated

E

E

E

E

E

E

E

Correct answer

E glycopyrrolate / Robinul™​

 

Administration of glycopyrrolate in patients with an anastomotic leak after primary repair of esophageal atresia and tracheoesophageal fistula (EA/TEF) resulted in reduced oral secretions which helped in healing of the anastomotic dehiscence in a significant number of patients.

 

In a randomized control trial of patients with leak following esophageal atresia repair, patients were either administered intravenous glycopyrrolate in the dose of 8 μg/kg every eight hours or normal saline in the placebo group. There were 297 total EA/TEF patients and 21 patients in each group with comparable preoperative characteristics. All the cases had anastomotic leaks clinically detectable in the chest tube. Cumulative total chest tube output per patient for all patients in the treatment group was approximately 125 ml as compared to 370 ml in the placebo group (p=0.001). Anastomotic leak stopped in 16 cases (76%) in the treatment group, as compared to 6 cases (29%) in the placebo group (p=0.004). In the treatment group, diversion procedures were carried out in 2 out of 21 cases (10%), whereas in the placebo group, 52% of the patients (11/21) required such an intervention (p=0.003). At the time of discharge, the oral feeds could be started in 15 cases (15/21, 71%) in the treatment group, as compared to three (3/21, 14%) in the placebo group (p=0.0004).

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What is the paper reference of the above answer please

What is the paper reference of the above answer please

 

https://www.jpedsurg.org/article/S0022-3468(16)30585-1/fulltext