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Effects of cricoid pressure and remifentanil on the esophageal sphincters using high-resolution solid-state manometry
Örebro University, School of Health and Medical Sciences. Department of Anesthesiology and Intensive Care.
Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
2011 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, no 2, p. 209-215Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cricoid pressure has been shown to decrease the pressure in the lower esophageal sphincter (LES), increasing the risk of aspiration. Whether this reaction is due to pain associated with the application of cricoid pressure has not been studied. The aim of this study was to compare the effects of cricoid pressure with those of peripheral pain on pressures in the LES, and to study whether remifentanil influences these effects. Data from the upper esophageal sphincter (UES) are also described.

METHODS: Continuous solid-state manometry was performed in 14 healthy volunteers. Initially, the effect of remifentanil (target-controlled infusion with a plasma target concentration of 5.0 ng/ml) was studied, and thereafter, the effects of cricoid pressure and peripheral pain stimulation (cold stimulation). Finally, these two interventions were repeated under ongoing remifentanil infusion.

RESULTS: Remifentanil decreased the LES pressure significantly [ΔP-6.5 mmHg, 95% confidence interval (95% CI) -1.7 to -11.2]. Cricoid pressure application decreased the LES pressure significantly (ΔP-3.7 mmHg, 95% CI -1.4 to 6.1), whereas peripheral pain did not (ΔP 1.2 mmHg, 95% CI -3.5 to 1.1). Under ongoing remifentanil infusion, no cricoid pressure-induced LES relaxation was observed. Cricoid pressure induced high pressures in the area of the UES, 215.7 (±91.2) mmHg without remifentanil vs. 219.4 (±74.2) mmHg with remifentanil.

CONCLUSIONS: Remifentanil as well as cricoid pressure per se induced decreases in LES pressure. However, cricoid pressure-induced changes of the barrier pressure were not significant whether induced with or without an infusion of remifentanil.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2011. Vol. 55, no 2, p. 209-215
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
URN: urn:nbn:se:oru:diva-15386DOI: 10.1111/j.1399-6576.2010.02367.xISI: 000286208600010PubMedID: 21226863Scopus ID: 2-s2.0-78651516200OAI: oai:DiVA.org:oru-15386DiVA, id: diva2:412892
Available from: 2011-04-26 Created: 2011-04-26 Last updated: 2018-02-20Bibliographically approved
In thesis
1. 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
Keyword
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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Ahlstrand, RebeccaSavilampi, JohannaThörn, Sven-EgronWattwil, Magnus

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