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High-resolution solid-state manometry of the upper and lower esophageal sphincters during anesthesia induction: a comparison between obese and non-obese patients
Örebro University, School of Health and Medical Sciences.
2010 (English)In: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 111, no 1, p. 149-153Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The prevalence of obesity has increased dramatically in recent decades. The gastrointestinal changes associated with obesity have clinical significance for the anesthesiologist in the perioperative period. The lower esophageal sphincter and the upper esophageal sphincter play a central role in preventing regurgitation and aspiration. The effects of increased intra-abdominal pressure during anesthesia on the lower esophageal sphincter and the upper esophageal sphincter in obese patients are unknown. In the present study we evaluated, with high-resolution solid-state manometry, the upper esophageal sphincter, lower esophageal sphincter, and barrier pressure (BrP) (lower esophageal pressure - gastric pressure) in obese patients during anesthesia induction and compared them with pressures in non-obese patients. METHODS: We studied 28 patients, ages 18 to 72 years, 14 with a body mass index >= 35kg/m(2), who were undergoing laparoscopic gastric bypass, and 14 with a body mass index <= 30kg/m(2), who were undergoing laparoscopic cholecystectomy, using high-resolution solid-state manometry. RESULTS: Upper esophageal sphincter pressure decreased during anesthesia induction in both groups. Lower esophageal sphincter pressure decreased in both groups during anesthesia induction, and it was significantly lower in obese patients than in non-obese patients. The BrP decreased in both groups and was significantly lower in the obese group than in the non-obese group. The BrP remained positive at all times in both groups. CONCLUSION: Lower esophageal sphincter and BrPs decreased in both obese and non-obese patients during anesthesia induction, but were significantly lower in obese patients. Although the BrP was significantly lower, it remained positive in all patients. (Anesth Analg 2010;111:149-53)

Place, publisher, year, edition, pages
2010. Vol. 111, no 1, p. 149-153
National Category
Medical and Health Sciences Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-15389DOI: 10.1213/ANE.0b013e3181e1a71fISI: 000279281500027OAI: oai:DiVA.org:oru-15389DiVA, id: diva2:412905
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

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de Leon, AlexThörn, Sven-EgronWattwil, Magnus

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