Gastro-Oesophageal Pressure Gradient Changes Produced by Induction of Anaesthesia and Suxamethonium

Gastro-esophageal regurgitation (GER) and eventual aspiration is considered a major risk during general anesthesia. High intraperitoneal pressure produced during laparoscopic cholecystectomy (LC) is a possible source of increased GER. We investigated the incidence of GER using continuous esophageal pH monitoring in 14 patients undergoing elective LC. Only two brief episodes of acid reflux (pH < 4) occurred during LC. Apparently the high intraperitoneal pressure during LC carries no increased risk of regurgitation and aspiration.

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“…These findings were supported by Smith et al [16]. Jones et al [10] showed this adaptive response of LES during laparoscopy.…”

Section: Discussionsupporting

confidence: 59%

Continuous esophageal pH monitoring during laparoscopic cholecystectomy

et al. 1994

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“…Abdominal fasciculations are diminished by a defasciculating dose of a non-depolarizing muscle relaxant. In addition, the tone of the lower oesophageal sphincter is increased to a similar extent or more than intragastric pressure [10]. Generally, regurgitation is not expected to occur before the increase in intragastric pressure exceeds 28 cmH 2 O.…”

Section: Succinylcholine For Rapid-sequence Inductionmentioning

confidence: 99%

Choice of the muscle relaxant for rapid-sequence induction

Sparr¹

2001

Eur J Anaesthesiol

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Muscle relaxants are given as part of a rapid-sequence induction to facilitate tracheal intubation. Among all the muscle relaxants available, succinylcholine is the only one with a fast (ffi1 min) onset and a fast recovery. Therefore it is still the most frequently used muscle relaxant for rapid-sequence induction despite its wellknown side-effects. The short duration of action of succinylcholine is, however, no substitute for aggressive airway management in the case of an unexpectedly difficult intubation in order to prevent life-threatening hypoxia. A preoperative assessment of the airway is mandatory in any patient and may indicate the need for using intubation techniques without a muscle relaxant. Rocuronium in large doses (i.e. !1 mg kg À1 ) is an alternative to succinylcholine in a classical rapid-sequence setting under relatively light anaesthesia. With respect to rapid tracheal intubation, the timing and priming principles offer little advantage over the use of rocuronium in doses of 0.6 mg kg À1 in combination with an appropriate induction technique (i.e. including an opioid) or over the use of larger doses of rocuronium (!1.0 mg kg À1 ) under relatively light anaesthesia, and may even be potentially harmful.In contrast to rocuronium, the use of rapacuronium in a rapid-sequence setting has been associated with dose-dependent respiratory side-effects that limit its usefulness in doses higher than 1.5 mg kg À1 for this indication.

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“…Some of the drugs used in this study are known to decrease the LOS pressure, including thiopentone [12] and halothane [13]. No data for fentanyl are available, but other opioids are known to decrease the LOS pressure [9].…”

Section: Discussionmentioning

confidence: 99%