From the Research
The optimal position for gastric lavage in acute poisoning is not recommended as a routine practice, but if performed, it should be done with caution and in a left lateral decubitus position with the head lowered, as this position may help reduce the risk of aspiration and facilitate the procedure. The patient should be placed on their left side with their head slightly lower than their body, which helps to position the esophagus above the level of gastric contents, minimizing the chance of reflux or aspiration during the procedure. This position also takes advantage of the natural anatomy of the stomach, as the greater curvature of the stomach is on the left side, allowing for more effective removal of stomach contents 1. However, it is essential to note that gastric lavage carries serious risks, including hypoxia, dysrhythmias, laryngospasm, perforation of the GI tract or pharynx, fluid and electrolyte abnormalities, and aspiration pneumonitis 2. Therefore, gastric lavage should only be performed by trained medical professionals in appropriate clinical settings, and its use should be limited to rare cases where the patient's life is at risk following ingestion of a substance that is not adsorbed by activated charcoal 3.
Some key points to consider when deciding on the optimal position for gastric lavage include:
- The left lateral decubitus position may help reduce the risk of aspiration and facilitate the procedure 1
- Gastric lavage carries serious risks and should only be performed by trained medical professionals in appropriate clinical settings 2
- The use of gastric lavage should be limited to rare cases where the patient's life is at risk following ingestion of a substance that is not adsorbed by activated charcoal 3
- Activated charcoal is now the agent of choice for most poisons, and its use should be prioritized over gastric lavage 4
- Protocols for care of overdose patients should be modified to reflect the limited role of gastric lavage and the preferred use of activated charcoal 4.
Overall, the decision to perform gastric lavage and the optimal position for the procedure should be made on a case-by-case basis, taking into account the specific circumstances of the poisoning and the potential risks and benefits of the procedure 5.