Intraoperative gastroesophageal reflux in dogs undergoing mastectomy under opioid-based protocols: a preliminary endoscopic study

Gastro‑oesophageal reflux (GER) is a common but underdiagnosed anaesthetic complication in dogs. Although locoregional techniques and other intravenous protocols are available to control pain during mastectomy, the use of opioids and their association with intraoperative GER during this procedure are poorly understood. This preliminary study aimed to evaluate and visualise the possible presence of relaxation of the lower oesophageal sphincter (LES) and gastric reflux in swollen breasts undergoing mastectomy. To achieve this, twelve bitches undergoing unilateral mastectomy underwent oesophageal endoscopy during the procedure to visualise relaxation of the lower oesophageal sphincter (LES) and gastric reflux. The anaesthetic protocol included midazolam combined with morphine or tramadol. Gastro‑oesophageal reflux was observed in 100% (12/12) of bitches during endoscopic monitoring, which began approximately 45 min after induction and continued throughout surgery, with 58% classified as mild and 42% as severe. LES relaxation was observed in all cases. One bitch had pre-existing oesophagitis. The small sample size and the lack of a control group limit generalisability. This preliminary study observed a 100% incidence of intraoperative GER in bitches undergoing mastectomy. However, due to the lack of a non-surgical control group, it was not possible to differentiate whether this was attributable to the surgical procedure itself or the known effects of the opioid-based anaesthetic protocol. These preliminary, hypothesis-generating findings highlight the need for controlled studies to quantify the specific risk associated with mastectomy. Intraoperative vigilance remains essential.