Metoclopramide Does Not Attenuate Cricoid Pressure–induced Relaxation of the Lower Esophageal Sphincter in Awake Volunteers

Salem, M. Ramez; Bruninga, Keith; Dodlapatii, Jyothi; Joseph, Ninos J.

doi:10.1097/aln.0b013e31818a37dc

Cited by 23 publications

(14 citation statements)

References 42 publications

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“…However, there are also concerns that CP may promote vomiting by causing relaxation of the lower oesophageal sphincter, 58,59 an effect which cannot be attenuated by the prior administration of metoclopramide. 60 Initially confirmed in awake volunteers, recent work on anaesthetised patients has suggested the effect is pronounced, with an overall 29% decrease in lower oesophageal sphincter pressure and a 44% reduction in barrier pressure. 61 Cadaver studies and case reports have shown that rupture of the oesophagus may occur secondary to CP.…”

Section: Does Cp Contribute To Adverse Events?mentioning

confidence: 98%

Cricoid pressure: The argument against

Turnbull

Patel

2015

Trends in Anaesthesia and Critical Care

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Section: Does Cp Contribute To Adverse Events?mentioning

confidence: 98%

Cricoid pressure: The argument against

Turnbull

Patel

2015

Trends in Anaesthesia and Critical Care

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“…The authors concluded that Metoclopramid may have a role in increasing barrier pressure when the cricoid pressure is not applied or has to be released. 88 Studies using advanced imaging techniques such as MRI and CT scanning have shown the oesophagus to be displaced laterally rather than occluded with the cricoid pressure 89,90 [III]. Smith et al, 89 in a recent study of healthy volunteers, using MRI scanning, found the oesophagus to be displaced laterally in over half of the patients without cricoid pressure, increasing to 90.5% when cricoid pressure was applied.…”

Section: Efficacy Of the Cricoid Pressurementioning

confidence: 99%

“…The physiological response to applied cricoid pressure deserves some mention. Application of the cricoid pressure has been shown to lower the LES tone and may be a contributing factor facilitating regurgitation and aspiration 78,87,88 [V]. Metoclopramid increases LES pressure but a recent study failed to show a benefit in terms of overcoming the cricoid pressure-induced lowering of the LES tone.…”

Section: Efficacy Of the Cricoid Pressurementioning

confidence: 99%

Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

Jensen

Callesen

Hagemo

et al. 2010

Acta Anaesthesiol Scand

115

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Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high‐grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients should be given by, or under very close supervision by, experienced anaesthesiologists. Problems with the airway and the circulation must be anticipated. The risk of aspiration must be judged for each patient. Pre‐operative gastric emptying is rarely indicated. For pre‐oxygenation, either tidal volume breathing for 3 min or eight deep breaths over 60 s and oxygen flow 10 l/min should be used. Pre‐oxygenation in the obese patients should be performed in the head‐up position. The use of cricoid pressure is not considered mandatory, but can be used on individual judgement. The hypnotic drug has a minor influence on intubation conditions, and should be chosen on other grounds. Ketamine should be considered in haemodynamically compromised patients. Opioids may be used to reduce the stress response following intubation. For optimal intubation conditions, succinylcholine 1–1.5 mg/kg is preferred. Outside the operation room, rapid sequence intubation is also considered the safest method. For all patients, precautions to avoid aspiration and other complications must also be considered at the end of anaesthesia.

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“…14,15 Although metoclopramide has been reported to increase LES pressure, its effects on EGJ compliance have not been evaluated. [4][5][6][7][8] Therefore, the aim of the present study was to investigate the effects of metoclopramide on esophageal motor activities and EGJ compliance in healthy volunteers, for which we employed the EndoFLIP system and high-resolution 36-channel manometry.…”

Section: 13mentioning

confidence: 99%

“…As a result, metoclopramide augments gastrointestinal motility and enhances gastric emptying, and also increases lower esophageal sphincter (LES) tone. [4][5][6][7][8] It has recently been reported that esophageal motor activities and compliance of the esophagogastric junction (EGJ) is important for prevention of gastroesophageal reflux, with the latter considered to cause greater volume reflux of gastric contents into the esophagus. [9][10][11] Fundoplication surgery for repairing the EGJ has been consistently shown to prevent pathological gastroesophageal reflux by restoration of normal EGJ compliance.…”

Section: Introductionmentioning

confidence: 99%

Effects of Metoclopramide on Esophageal Motor Activity and Esophagogastric Junction Compliance in Healthy Volunteers

Mikami

Ishimura

Fukazawa³

et al. 2015

J Neurogastroenterol Motil

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Background/AimsProkinetic drugs such as metoclopramide are frequently used as second-line therapy for patients with gastroesophageal reflux disease. However, their beneficial effects remain unclear. Esophageal motor activities and compliance of the esophagogastric junction (EGJ) are important for prevention of gastroesophageal reflux. Although metoclopramide has been reported to increase lower esophageal sphincter (LES) pressure, its effects on EGJ compliance have not been evaluated. In the present study, we investigated the effects of metoclopramide on esophageal motor activities and EGJ compliance. MethodsNine healthy male volunteers without abdominal symptoms were enrolled. Peristaltic esophageal contractions and LES pressure were examined using high-resolution esophageal manometry, while EGJ compliance was evaluated with an endoluminal functional lumenimaging probe. After obtaining baseline values for esophageal motor activities and EGJ compliance, metoclopramide (10 mg) was intravenously administered, then all measurements were repeated at 15 minutes after administration in each subject. ResultsFollowing administration of metoclopramide, mean resting LES pressure was significantly increased as compared with the baseline (13.7 ± 9.2 vs 26.7 ± 8.8 mmHg, P < 0.05). In addition, metoclopramide significantly augmented peristaltic contractions, especially in the distal esophageal segment (P < 0.05). On the other hand, distensibility index did not change after administration (4.5 ± 0.5 vs 4.1 ± 0.5 mm 2 /mmHg), suggesting no significant effect of metoclopramide on EGJ compliance. ConclusionsMetoclopramide augmented esophageal contractions without changing EGJ compliance in healthy adults.(J Neurogastroenterol Motil 2016;22:112-117)

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Metoclopramide Does Not Attenuate Cricoid Pressure–induced Relaxation of the Lower Esophageal Sphincter in Awake Volunteers

Cited by 23 publications

References 42 publications

Cricoid pressure: The argument against

Cricoid pressure: The argument against

Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

Effects of Metoclopramide on Esophageal Motor Activity and Esophagogastric Junction Compliance in Healthy Volunteers

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