The effect on lower esophageal sphincter (LES) pressure of IV atropine and neostigmine, a drug combination routinely given to antagonize nondepolarizing neuromusclar blockade at the end of a general anesthetic, was studied in 22 patients undergoing cesarean section. Atropine 1.2 mg and neostigmine 2.5 mg IV decreased LES pressure insignificantly by a mean of 0.7 kPa (p less than 0.1). In contrast, atropine 1.2 mg and neostigmine 5 mg increased LES pressure by a mean of 1.4 kPa (p less than 0.001). The latter dosage of this drug combination, therefore, appears preferable in patients presenting for emergency surgery if the integrity of the lower esophageal sphincter is to be maintained during extubation and recovery from general anesthesia.
The effects of five antiemetic drugs on the lower oesophageal sphincter (LOS) were studied in five groups, each comprising eight healthy volunteers. Cyclizine, prochlorperazine and metoclopramide have a desirable functional effect on LOS, while promethazine and droperidol were associated with evidence of increased gastro-oesophageal reflux.
The effects of intravenous metoclopramide (Maxolon) on the lower oesophageal sphincter (LOS) were studied in three groups of patients, one group being normal control and the other two being pregnant females, one without heartburn and the other with. Metoclopramide increases the LOS pressure 20•5,15•2 and 10•2cm HP respectively (P <0'005, p <0•005 and p <0•05). These findings suggest that for patients undergoing elective or emergency obstetrical anaesthesia, intravenous metoclopramide may help reduce the incidence of regurgitation of gastric contents.
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