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Effects of propofol on oesophageal sphincters: a study on young and elderly volunteers using high-resolution solid-state manometry
Örebro University, School of Health and Medical Sciences.
Örebro University, School of Health and Medical Sciences.
Örebro University, School of Health and Medical Sciences.
2011 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 28, no 4, p. 273-278Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND OBJECTIVE:

The oesophageal sphincters play an important role in protecting the airway. During manometric studies, administration of an anxiolytic agent is often required to make insertion of the catheter acceptable for the patient. The anxiolytic should not affect the results of the measurements. This study evaluates the effects of two different doses of propofol on the pressures in the oesophageal sphincters. The effect of increased abdominal pressure was also studied.

METHODS:

Twenty healthy volunteers, 10 young (mean age 25 years) and 10 elderly (mean age 71 years), were recruited. The effects of a low dose of propofol [0.3 mg kg(-1) intravenously (i.v.)] and a high dose of propofol (young group 0.9 mg kg(-1) i.v. and elderly group 0.6 mg kg(-1) i.v.) were studied with and without external abdominal pressure.

RESULTS:

There were no statistically significant changes in lower oesophageal sphincter (LOS) pressure after the low dose of propofol. After the high dose, there was an increase in LOS pressure, which was statistically significant in the young group (P < 0.05). The upper oesophageal sphincter (UOS) pressure decreased after both doses of propofol (P < 0.01 for the higher dose and P < 0.05 for the lower dose).

CONCLUSION:

A low dose of propofol (0.3 mg kg(-1) i.v.) leaves the LOS unaffected in young and elderly volunteers and can be used safely as an anxiolytic agent during studies of the LOS without influencing the results. However, the UOS is more sensitive to the effects of propofol and we do not recommend the use of propofol as an anxiolytic agent during manometric studies of the UOS.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2011. Vol. 28, no 4, p. 273-278
National Category
Medical and Health Sciences Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
URN: urn:nbn:se:oru:diva-15384DOI: 10.1097/EJA.0b013e3283413211ISI: 000288196000009PubMedID: 21119519Scopus ID: 2-s2.0-79953874254OAI: oai:DiVA.org:oru-15384DiVA, id: diva2:412880
Available from: 2011-04-26 Created: 2011-04-26 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
Keywords
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
2. Effects of anasthesia on esophageal sphincters
Open this publication in new window or tab >>Effects of anasthesia on esophageal sphincters
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The esophageal sphincters constitute the anatomical protection against pulmonary aspiration. The aim of this thesis was to study the esophageal sphincters and how they are affected by different components of emergency anesthesia using high-resolution solid-state manometry.

The effect of propofol (0.3 mg/kg) was studied in young and elderly volunteers. Propofol can be given as an anxiolytic agent for manometric studies of the lower esophageal sphincter (LES) without affecting the results. However, propofol is not recommended for studies of the upper esophageal sphincter (UES).

The effects of cricoid pressure (CP) and peripheral pain were studied in awake volunteers, with and without remifentanil infusion (5 ng/ml). Pain did not affect pressure in the LES, but CP or remifentanil induced a significant decrease in LES pressure. However, neither CP nor remifentanil affected the barrier pressure (LES-intra gastric pressure). When CP was applied during ongoing remifentanil infusion, no further decrease in LES pressure was measured. CP induced high pressures in the area of the UES independent of remifentanil infusion, indicating that CP is effective in preventing gastroesophageal regurgitation.

Barrier pressure was also studied in anesthetized patients after rocuronium (0.6 mg/kg) administration and no decrease was measured. In addition, alfentanil (20 μ/kg) added during anesthesia induction with propofol did not decrease the barrier pressure.

In conclusion, CP seems to be effective in preventing regurgitation and does not affect barrier pressure. Muscle relaxation with rocuronium does not risk gastro-esophageal integrity. In addition, opioids can be integrated, even during emergency anethesia, without increasing the risk for pulmonary aspiration.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2011. p. 50
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 55
Keywords
Lower esophageal shincter, Upper esophageal sphincter, Barrier pressure, Manometry, Propofol, Remifentanil, Alfentanil, Rocuronium, Cricoid pressure
National Category
Medical and Health Sciences Surgery Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
urn:nbn:se:oru:diva-15271 (URN)978-91-7668-799-4 (ISBN)
Public defence
2011-06-01, Wilandersalen, Universitetssjukhuset Örebro, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-04-15 Created: 2011-04-15 Last updated: 2017-10-17Bibliographically approved

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de Leon, AlexAhlstrand, RebeccaThörn, Sven-EgronWattwil, Magnus

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