1984
DOI: 10.1093/bja/56.1.37
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The Lower Oesophageal Sphincter and Anaesthesia

Abstract: Since Fyke, Code and Schlegel (1956) first demonstrated the existence of a high pressure zone at the lower end of the oesophagus, there has been increasing interest shown in this structure by anaesthetists. This area is termed the lower oesophageal sphincter (LOS) and is the major barrier preventing regurgitation of acid gastric contents into the oesophagus. This is of considerable concern to anaesthetists, as any regurgitated material may be aspirated into the lungs and produce the acid aspiration (Mendelson'… Show more

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Cited by 137 publications
(61 citation statements)
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“…Further, most intravenous induction drugs and opioids reduce esophageal sphincter tone, thus increasing the risk of regurgitation. 41,42 The goal of RSI therefore is to achieve a state that allows tracheal intubation but minimizes the time that patients are at risk for regurgitation and aspiration. The generally accepted practice regarding drug administration during RSI is rapid administration of predetermined doses.…”
Section: Should All Drugs Be Rapidly Administered During Rsi?mentioning
confidence: 99%
“…Further, most intravenous induction drugs and opioids reduce esophageal sphincter tone, thus increasing the risk of regurgitation. 41,42 The goal of RSI therefore is to achieve a state that allows tracheal intubation but minimizes the time that patients are at risk for regurgitation and aspiration. The generally accepted practice regarding drug administration during RSI is rapid administration of predetermined doses.…”
Section: Should All Drugs Be Rapidly Administered During Rsi?mentioning
confidence: 99%
“…An alternative method would be to titrate the doses of drugs over a more prolonged time period. The rationale for rapidly administering pre-determined doses is that the majority of hypnotics and opioids reduce both the upper and the lower oesophageal sphincter (LES) tone 11,12 and thus increase the risk of regurgitation. The goal of maximal injection of speed is to rapidly achieve a state of anaesthesia, which allows fast tracheal intubation and in this way reduces the time during which patients are at risk of gastric aspiration.…”
Section: Introductionmentioning
confidence: 99%
“…Patients who have a "full stomach" are at risk of aspiration during sedation or general anesthesia due to reduction of the tonus of the lower esophageal sphincter and also protective airway reflexes. 6,7 Certain factors have been associated with the severity of the evolution of patients suffering from pulmonary aspiration, including the volume, nature and the pH of the aspirated material. [8][9][10][11] The preoperative assessment of the risk of pulmonary aspiration is essentially based on the patient's history, and clinical management typically follows the fasting recommendations of the current guidelines.…”
mentioning
confidence: 99%