The Effects of Cricoid Pressure, Remifentanil, and Propofol on Esophageal Motility and the Lower Esophageal Sphincter

Department of Anesthesiology and Intensive Care, Orebro University Hospital, 701 85 Orebro, Sweden.
Anesthesia & Analgesia (Impact Factor: 3.47). 04/2005; 100(4):1200-3. DOI: 10.1213/01.ANE.0000147508.31879.38
Source: PubMed


Cricoid pressure is the gold standard during the induction of anesthesia when there is a risk of aspiration of gastric contents. However, the effect of cricoid pressure during the different steps of complete anesthesia induction has not been studied. The purpose of this study was to investigate the effects of cricoid pressure, remifentanil, and propofol on lower esophageal sphincter (LES) and esophageal motility. We recorded LES pressure (LESP) and calculated barrier pressure ([BrP] = LESP - gastric pressure) in 10 healthy volunteers using a Dent sleeve device. There was a significant decrease in LESP and BrP when a cricoid pressure of 30 N was performed in the awake volunteers (P < 0.05). However, this effect was not seen during the infusion of remifentanil 0.2 microg . kg(-1) . min(-1). Remifentanil per se or together with a bolus dose of propofol 1 mg/kg IV did not induce any statistical change in LESP or BrP. Remifentanil abolished spontaneous esophageal motility and completely eliminated the experience of discomfort induced by cricoid pressure. In conclusion, cricoid pressure of 30 N induced a decrease of LESP and BrP in awake volunteers. These effects were not seen during the remifentanil infusion. This shows the importance of when to apply cricoid pressure during rapid-sequence induction.

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    • "The results demonstrated increased reflux with propofol but no significant change with thiopentone. Thorn et al. compared the effect of propofol with remifentanil and concluded that both anesthetics did not have a significant effect on LES pressure or esophageal motility [3]. Studies by Marsh et al. and Fung et al. evaluated the effect of midazolam on esophageal motility [4] [8]. "
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    ABSTRACT: Background/Aim. The aim of this study was to determine the effect of propofol on acid reflux as measured with the Bravo pH monitoring system. Methods. 48-hour pH tracings of 88 children were retrospectively evaluated after placement of the Bravo capsule under propofol. Comparisons between day 1 and day 2, as well as 6-hour corresponding segments from day 1 and day 2, were made. Results. The number of reflux episodes was significantly increased during the first six-hour period on day one as compared to day 2 (P = 0.006). The fraction of time the pH was <4 was also increased during this period, though it did not reach statistical significance. When comparing full 24-hour periods, there was no difference noted in either the number of reflux episodes or the fraction of time pH < 4 between day one and day two. Conclusion. Our data suggest an increase in gastroesophageal reflux during the postanesthesia period. This could be a direct effect of propofol, or related to other factors. Regardless of the cause, monitoring of pH for the first 6 hours following propofol administration may not be reliable when assessing these patients. Monitoring pH over a prolonged 48-hour time period can overcome this obstacle.
    04/2013; 2013:605931. DOI:10.1155/2013/605931
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    • "La prise en charge d'une dysphagie basse repose avant tout sur la réalisation d'une endoscopie digestive haute : celle-ci peut être normale, mais il faut s'attacher à identifier des signes tels qu'une stase salivaire, un ressaut au passage du cardia (plus difficile à évaluer avec les endoscopes fins de dernière génération), un aspect atone du corps de l'oesophage, ou au contraire hypertonique (contractions répétées de grande amplitude, spasmes localisés). La réalisation de l'examen sous anesthésie modifie sans doute la motricité oesophagienne, et peut participer au retard au diagnostic très fréquemment observé dans ce contexte [8]. "
    F Mion · S Roman ·
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    ABSTRACT: Oropharyngeal dysphagia is very rare in young adults. Thoracic dysphagia work-up must include upper GI endoscopy and esophageal biopsies, to exclude eosinophilic esophagitis, which requires specific treatment with corticosteroids and endoscopic dilations. Esophageal manometry and barium swallow must be performed if upper GI endoscopy and biopsies are negative. High-resolution esophageal manometry, by disclosing a true functional imaging of swallow, appears as a real breakthrough for the diagnosis of dysphagia occurring after antireflux and bariatric surgery.
    Gastroentérologie Clinique et Biologique 09/2009; 33(10-11 Suppl):F82-7. · 1.14 Impact Factor
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    ABSTRACT: Die überwiegende Mehrheit aller Anästhesisten hält die Anwendung von Krikoiddruck aus Gründen der Patientensicherheit für einen unabdingbaren Bestandteil einer jeden Anästhesieschnelleinleitung. Krikoiddruck wird unter der Vorstellung angewendet, dadurch die Regurgitation von in den Ösophagus gelangtem Mageninhalt in den Pharynx mit anschließender pulmonaler Aspiration zu verhindern. Diese Übersichtsarbeit schildert den Hintergrund der Einführung des Krikoiddrucks in die klinische Praxis, analysiert die publizierten Daten hinsichtlich der klinischen Relevanz der perioperativen pulmonalen Aspiration und der Effektivität des Krikoiddrucks, diese zu verhindern, diskutiert Probleme bei dessen Ausübung, bewertet Kenntnisstand und technische Ausübung des Krikoiddrucks und präsentiert diverse aktuelle Empfehlungen zu dessen Anwendung. Vor dem Hintergrund gänzlich fehlender Evidenz für die Effektivität des Krikoiddrucks zur Prävention der pulmonalen Aspiration bei gleichzeitigem Vorliegen zahlreicher Berichte über eine teilweise klinisch relevante Beeinträchtigung des Atemwegsmanagements während dessen Ausübung muss die Empfehlung für die generelle Anwendung von Krikoiddruck während einer Schnelleinleitung ernsthaft infrage gestellt werden. The vast majority of anaesthetists considers application of cricoid pressure for reasons of patient safety an integral part of rapid sequence induction. Cricoid pressure is applied with the idea that it will prevent regurgitation of gastric content into the pharynx, thereby reducing the incidence of pulmonary aspiration. This review describes the background of the introduction of cricoid pressure into clinical practice, analyzes published data concerning clinical relevance of perioperative pulmonary aspiration and efficacy of cricoid pressure in reducing it, discusses problems associated with its use, assesses knowledge and technical performance of cricoid pressure and presents various recent recommendations regarding application of cricoid pressure. The combination of complete lack of evidence for the efficacy of cricoid pressure in preventing pulmonary aspiration and numerous reports of clinically relevant interference with airway management during its use, seriously question the rationale of recommending the general use of cricoid pressure during rapid sequence induction.
    Der Anaesthesist 07/2009; 58(7):695-707. DOI:10.1007/s00101-009-1548-6 · 0.76 Impact Factor
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