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Integrity of the esophagogastric junction during propofol induction with and without remifentanil: a double-blind,randomized, crossover study in volunteers
Örebro University, School of Health and Medical Sciences.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Context: Practice varies regarding the use of opioids during rapid sequence induction. Controversy exists as to whether opioids may increase the risk of pulmonary aspiration by decreasing the barrier pressure (lower oesophageal sphincter pressure – intragastric pressure).

Objectives: To evaluate the effects of adding alfentanil during anaesthesia induction with propofol with respect to the barrier pressure in the oesophagogastric junction.

Participants and Setting: Seventeen healthy volunteers (11 males and 6 females) participated in a double-blind, randomised, crossover trial at the University Hospital in Örebro, Sweden.

Interventions and outcome measures: The volunteers were anaesthetised on two different occasions, randomly assigned to receive either alfentanil 20 g kg ˉ1 or an equivalent amount of saline, administered intravenously, one minute before induction with propofol 2 mg kg ˉ1. One minute after propofol administration, a cricoid pressure of 30N was applied. The primary outcome was the difference in the change in barrier pressure between the alfentanil and the placebo occasion one minute after propofol administration. The secondary outcomes were differences in the changes in barrier pressure one minute after alfentanil or placebo administration and during ongoing cricoid pressure application.

Results: There were no statistically significant differences in barrier pressure, at any time point, between anaesthesia induction with alfentanil and propofol compared with induction with placebo and propofol. The barrier pressure never decreased to less than 2.4 mmHg in any volunteer.

Conclusion: Our study showed no increased risk regarding the integrity of the gastrooesophageal junction when alfentanil is added during an induction with propofol in volunteers. This supports the practice of adding opioids as adjuvants during rapid sequence induction.

National Category
Medical and Health Sciences Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
URN: urn:nbn:se:oru:diva-15388OAI: oai:DiVA.org:oru-15388DiVA, id: diva2:412901
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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