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Effects of different respiratory maneuvers on esophageal sphincters in obese patients before and during anesthesia
Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences. Örebro University Hospital, Örebro, Sweden.
Lindesberg Hosp, Dept Surg, Lindesberg, Sweden.
Lindesberg Hosp, Dept Surg, Lindesberg, Sweden; Örebro University Hospital, Örebro, Sweden.
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2010 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 54, no 10, p. 1204-1209Article in journal (Refereed) Published
Abstract [en]

Background: Data on esophageal sphincters in obese individuals during anesthesia are sparse. The aim of the present study was to evaluate the effects of different respiratory maneuvers on the pressures in the esophagus and esophageal sphincters before and during anesthesia in obese patients.

Methods: Seventeen patients, aged 28-68 years, with a BMI >= 35 kg/m2, who were undergoing a laparoscopic gastric by-pass surgery, were studied, and pressures from the hypopharynx to the stomach were recorded using high-resolution solid-state manometry. Before anesthesia, recordings were performed during normal spontaneous breathing, Valsalva and forced inspiration. The effects of anesthesia induction with remifentanil and propofol were evaluated, and positive end-expiratory pressure (PEEP) 10 cmH(2)O was applied during anesthesia.

Results: During spontaneous breathing, the lower esophageal sphincter (LES) pressure was significantly lower during end-expiration compared with end-inspiration (28.5 +/- 7.7 vs. 35.4 +/- 10.8 mmHg, P < 0.01), but barrier pressure (BrP) and intra-gastric pressure (IGP) were unchanged. LES, BrP (P < 0.05) and IGP (P < 0.01) decreased significantly during anesthesia. BrP remained positive in all patients. IGP increased during Valsalva (P < 0.01) but was unaffected by PEEP. Esophageal pressures were positive during both spontaneous breathing and mechanical ventilation. Esophageal pressures increased during PEEP from 9.4 +/- 3.8 to 11.3 +/- 3.3 mmHg (P < 0.01).

Conclusion: During spontaneous breathing, the LES pressure was the lowest during end-expiration but there were no differences in BrP and IGP. LES, BrP and IGP decreased during anesthesia but BrP remained positive in all patients. During the application of PEEP, esophageal pressures increased and this may have a protective effect against regurgitation.

Place, publisher, year, edition, pages
Malden, USA: Wiley-Blackwell, 2010. Vol. 54, no 10, p. 1204-1209
National Category
Medical and Health Sciences Infectious Medicine
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-12872DOI: 10.1111/j.1399-6576.2010.02305.xISI: 000282687400007PubMedID: 20840514Scopus ID: 2-s2.0-78650198233OAI: oai:DiVA.org:oru-12872DiVA: diva2:383504
Available from: 2011-01-05 Created: 2011-01-03 Last updated: 2017-12-11Bibliographically 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. p. 48
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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