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High resolution solid-state manometry of the effect of rocuronium on esophagogastric junction integrity
Örebro University, School of Health and Medical Sciences.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: The pressure in the lower esophageal sphincter (LES) is partly dependent on striated muscles derived from the crural portion of the diaphragm. The effect of neuromuscular blockade on the integrity of the esophagogastric junction is not well studied. We conducted a prospective interventional study to determine the effect of rocuronium on the pressure in the LES and the barrier pressure (LES pressure – intra gastric pressure). We also studied the effect of positive pressure ventilation on the barrier pressure after neuromuscular blockade with rocuronium.

Methods: Fourteen patients classified as ASA I or II (aged 18-75 years) who presented for elective surgery (11 cholecystectomy, 3 inguinal hernia) participated in the study. Esophageal manometry was performed after anesthetization with propofol, fentanyl and sevoflurane. After the insertion of a laryngeal mask airway, the patients breathed spontaneously for one minute. Rocuronium was administrated and the patients observed during the onset of apnea and during one minute of apnea and complete neuromuscular blockade. Volume controlled positive pressure ventilation followed.

Results: Muscle relaxation with rocuronium showed no significant changes in barrier pressure comparing the pressure immediately before rocuronium administration with the pressure obtained at the time point of 0% TOF. Conversion to positive pressure ventilation did not change the barrier pressure with inspiration or expiration. The greatest decrease in barrier pressure was measured after inducing anesthesia when comparing pressures during inspiration (P< 0.01)

National Category
Medical and Health Sciences Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
URN: urn:nbn:se:oru:diva-15387OAI: oai:DiVA.org:oru-15387DiVA, id: diva2:412898
Available from: 2011-04-26 Created: 2011-04-26 Last updated: 2017-10-17Bibliographically 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
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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Ahlstrand, Rebecca

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