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Body positions and esophageal sphincter pressures in obese patients during anesthesia
Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
Örebro University Hospital, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
2010 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 4, 458-463 p.Article in journal (Refereed) Published
Abstract [en]

Background: The lower esophageal sphincter (LES) and the upper esophageal sphincter (UES) play a central role in preventing regurgitation and aspiration. The aim of the present study was to evaluate the UES, LES and barrier pressures (BP) in obese patients before and during anesthesia in different body positions.

Methods: Using high-resolution solid-state manometry, we studied 17 patients (27-63 years) with a BMI>or=35 kg/m(2) who were undergoing a laparoscopic bariatric surgery before and after anesthesia induction. Before anesthesia, the subjects were placed in the supine position, in the reverse Trendelenburg position (+20 degrees) and in the Trendelenburg position (-20 degrees). Thereafter, anesthesia was induced with remifentanil and propofol and maintained with remifentanil and sevoflurane, and the recordings in the different positions were repeated.

Results: Before anesthesia, there were no differences in UES pressure in the different positions but compared with the other positions, it increased during the reverse Trendelenburg during anesthesia. LES pressure decreased in all body positions during anesthesia. The LES pressure increased during the Trendelenburg position before but not during anesthesia. The BP remained positive in all body positions both before and during anesthesia.

Conclusion: LES pressure increased during the Trendelenburg position before anesthesia. This effect was abolished during anesthesia. LES and BPs decreased during anesthesia but remained positive in all patients regardless of the body position.

Place, publisher, year, edition, pages
Malden, USA: Wiley-Blackwell Publishing Inc., 2010. Vol. 54, no 4, 458-463 p.
National Category
Medical and Health Sciences Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
URN: urn:nbn:se:oru:diva-11649DOI: 10.1111/j.1399-6576.2009.02158.xISI: 000274932800012PubMedID: 19912128Scopus ID: 2-s2.0-77649215976OAI: oai:DiVA.org:oru-11649DiVA: diva2:345893
Available from: 2010-08-27 Created: 2010-08-27 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Effects of anesthesia on esophageal sphincters in obese patients
Open this publication in new window or tab >>Effects of anesthesia on esophageal sphincters in obese patients
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The lower esophageal sphincter (LES) and the upper esophageal sphincter (UES) play a central role in preventing regurgitation and aspiration. The aim of this thesis was to evaluate the UES, LES, esophageal (E) and barrier (Br) pressures (P) using high resolution solid state manometry (HRSM). Comparisons were made between obese and nonobese patients, before and during anesthesia induction, and in obese patients in different body positions and during different respiratory maneuvers.

Methods: The effects of low-dose propofol (0.3 mg/kg iv) were studied in 10 young (ages 18–30 years) and 10 elderly volunteers (ages 60–87 years). The effects of anesthesia induction with remifentanil, propofol and rocuronium were studied in 14 obese patients (BMI >35 kg/m2) and compared with effects in 14 non-obese patients. The effects of different body positions on esophageal sphincters were evaluated in 17 obese patients before and during anesthesia. The effects of different respiratory maneuvers on pressures in the esophagus and esophageal sphincters were studied before and during anesthesia in 17 obese patients. HRSM was used in all studies.

Results: The low propofol dose did not infl uence LES pressures in either young or elderly volunteers. Anesthesia induction with Remifentanil and Propofol decreased pressures in the esophageal sphincters and the BrP in both obese and non-obese patients. The pressures were signifi cantly lower in obese patients. The BrP remained positive in both obese and non-obese individuals. The LES pressure increased in the Trendelenburg position before but not during anesthesia. During spontaneous breathing the LES pressure was signifi cantly lower during end-expiration compared to end-inspiration. The LES pressure increased during the Valsalva maneuver and forced inspiration. With the patients in supine position the EP was positive during normal spontaneous breathing and during mechanical ventilation but was negative during forced inspiration. The EP increased signifi cantly during PEEP.

Conclusion: High-resolution solid-state manometry is a valuable tool for studying esophageal function. Lower esophageal sphincter pressure and barrier pressure decreased during anesthesia induction and were signifi cantly lower in obese compared to non-obese patients. However, barrier pressure remained positive in all patients. When evaluating the risk for regurgitation, the lowest lower esophageal sphincter pressure and barrier pressure are found during end-expiration. PEEP during anesthesia increased esophageal pressures and may therefore decrease the risk for passive regurgitation.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2010. 48 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 46
Keyword
Lower esophageal sphincter, upper esophageal sphincter, barrier pressure, obesity, high-resolution solid-state manometry, anesthesia
National Category
Medical and Health Sciences Surgery Anesthesiology and Intensive Care
Research subject
Surgery; Anaesthesiology
Identifiers
urn:nbn:se:oru:diva-11269 (URN)978-91-7668-743-7 (ISBN)
Public defence
2010-09-24, Wilandersalen, Universitetssjukhuset, Örebro, 09:00
Opponent
Supervisors
Available from: 2010-06-28 Created: 2010-06-28 Last updated: 2017-10-18Bibliographically approved

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de Leon, A.Wattwil, Magnus

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