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]. "
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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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    • "fluences on smooth - muscle sphincteric pressure . Martin et al . ( 1990 ) showed that fentanyl and vecuronium have no effect on the smooth muscle LOS . Propofal , succinylcholine and thiopental either have no effect or have a duration of action that is too short to significantly affect the smooth muscle LOS in this study ( Laitinen et al . 1978 ; Thorn et al . 2005 ) . Midazolam has a variable effect on the smooth muscle LOS in the literature . In one study ( March et al . 1993 ) it was found to increase LOS pressure while in another study ( Fung et al . 1992 ) it had no effect on LOS pressure . ( An increase in smooth muscle LOS pressure is not a negative attribute , in principle , since the cont"
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    ABSTRACT: Quantifications of gastro-oesophageal anatomy in cadavers have led some to identify the lower oesophageal sphincter (LOS) with the anatomical gastric sling-clasp fibres at the oesophago-cardiac junction (OCJ). However, in vivo studies have led others to argue for two overlapping components proximally displaced from the OCJ: an extrinsic crural sphincter of skeletal muscle and an intrinsic physiological sphincter of circular smooth-muscle fibres within the abdominal oesophagus. Our aims were to separate and quantify in vivo the skeletal and smooth muscle sphincteric components pharmacologically and clarify the description of the LOS. In two protocols an endoluminal ultrasound-manometry assembly was drawn through the human gastro-oesophageal segment to correlate sphincteric pressure with the anatomic crus. In protocol I, fifteen normal subjects maintained the costal diaphragm at inferior/superior positions by full inspiration/expiration (FI/FE) during pull-throughs. These were repeated after administering atropine to suppress the cholinergic smooth-muscle sphincter. The cholinergic component was reconstructed by subtracting the atropine-resistant pressures from the full pressures, referenced to the anatomic crus. To evaluate the extent to which the cholinergic contribution approximated the full smooth-muscle sphincter, in protocol II seven patients undergoing general anaesthesia for non-oesophageal pathology were administered cisatracurium to paralyse the crus. The smooth-muscle sphincter pressures were measured after lung inflation to approximate FI. The cholinergic smooth-muscle pressure profile in protocol I (FI) matched closely the post-cisatracurium smooth-muscle pressure profile in protocol II, and the atropine-resistant pressure profiles correlated spatially with the crural sling during diaphragmatic displacement. Thus, the atropine-resistant and cholinergic pressure contributions in protocol I approximated the skeletal and smooth muscle sphincteric components. The smooth-muscle pressures had well-defined upper and lower peaks. The upper peak overlapped and displaced rigidly with the crural sling, while the distal peak separated from the crus/upper-peak by 1.1 cm between FI and FE. These results suggest the existence of separate upper and lower intrinsic smooth-muscle components. The 'upper LOS' overlaps and displaces with the crural sling consistent with a physiological LOS. The distal smooth-muscle pressure peak defines a 'lower LOS' that likely reflects the gastric sling/clasp muscle fibres at the OCJ. The distinct physiology of these three components may underlie aspects of normal sphincteric function, and complexity of sphincter dysfunction.
    The Journal of Physiology 06/2007; 580(Pt.3):961-75. DOI:10.1113/jphysiol.2006.124032 · 5.04 Impact Factor
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