Effects of Dexmedetomidine and Propofol on Lower Esophageal Sphincter and Gastroesophageal Pressure Gradient in Healthy Volunteers

Turan, Alparslan; Wo, John; Kasuya, Yuko; Govinda, Raghavendra; Akça, Ozan; Dalton, Jarrod E.; Sessler, Daniel I.; Rauch, Stefan

doi:10.1097/01.anes.0000365963.97138.54

Cited by 28 publications

(20 citation statements)

References 34 publications

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“…Anesthetic agents, including midazolam, diazepam, thiopentone, remifentanil, and propofol, have shown to have different effects on the LES pressure and esophageal motility [2–9]. Galatos et al compared the effect of thiopentone and propofol on gastric esophageal reflux in cats [2].…”

Section: Discussionmentioning

confidence: 99%

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Effect of Propofol on Acid Reflux Measured with the Bravo pH Monitoring System

Chawla

Girda²,

Walker

et al. 2013

ISRN Gastroenterology

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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.

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Section: Discussionmentioning

confidence: 99%

“…A recent study by Turan et al concluded that propofol may cause some decrease in LES pressure at high concentrations of the drug administration [9]. None of the studies took into account possible secondary mechanisms involving factors such as level of activity, patient's position, and dietary intake.…”

Section: Discussionmentioning

confidence: 99%

Effect of Propofol on Acid Reflux Measured with the Bravo pH Monitoring System

Chawla

Girda²,

Walker

et al. 2013

ISRN Gastroenterology

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“…In our previous study [6], both agents caused dose-dependent reductions in lower esophageal sphincter pressures. There is no simple way to determine or estimate LESP; measurement of the sphincter pressure is a complicated process requiring expertise and special equipment.…”

Section: Discussionmentioning

confidence: 93%

“…We report a new analysis of results obtained during a previously published study in which we evaluated the effects of 2 different drugs and different doses on lower esophageal sphincter pressures [6]. …”

Section: Methodsmentioning

confidence: 99%

Correlation between Bispectral Index, Observational Sedation Scale, and Lower Esophageal Sphincter Pressure in volunteers using dexmedetomidine or propofol

et al. 2012

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SummaryBackgroundMany anesthetics reduce lower esophageal sphincter pressure (LESP) and consequently the gastro-esophageal pressure gradient (GEPG); thus they may promote gastro-esophageal reflux and contribute to aspiration pneumonia. Our goals were to evaluate the association between LESP and 2 measures of sedation: bispectral index (BIS) and the responsiveness component of the Observer’s Assessment of Alertness score (OAA/S).Material/MethodsEleven healthy volunteers were each sedated on 2 separate days. Subjects were given sedative infusions of increasing target plasma concentrations of dexmedetomidine or propofol. LESP and GEPG were recorded after starting each infusion phase. Generalized estimating equation modeling was used to assess the relationship between LESP and, respectively, BIS and OAA/S. The existence of a drug-dependent association was evaluated within these models by testing an interaction term. Wald tests were used to evaluate the relationships within the models.ResultsWe found a significant relationship between LESP and BIS (P=0.0043) after adjusting for the main effect of sedative type – a deepening of sedation as measured by a decrease in BIS of 10% was associated with a decrease [Bonferroni-adjusted 95% CI] in LESP of −1.34 [−2.39, −0.29] mmHg. After adjusting for the main effect of sedative drug, LESP significantly declined with declining OAA/S (P=0.001); a unit decrease of OAA/S was associated with a decrease [Bonferroni-adjusted 95% CI] in LESP of −2.01 [−3.20, −0.81] mmHg.ConclusionsDeeper sedation, as measured by either BIS or OAA/S, significantly reduces LESP.

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“…Because the other agents purported for use in hiccups, i.e., atropine and ephedrine, may cause unacceptable elevations in heart rate and blood pressure levels, we propose the use of dexmedetomidine. Also, dexmedetomedine does not promote gastroesophageal reflux,[5] which, by itself, is an etiological factor for hiccups.…”

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confidence: 99%