Effects of different respiratory maneuvers on esophageal sphincters in obese patients before and during anesthesia

Leon, Alex de; Thörn, Sven‐Egron; Raoof, Mustafa; Ottosson, Johan; Wattwil, Magnus

doi:10.1111/j.1399-6576.2010.02305.x

Cited by 7 publications

(6 citation statements)

References 12 publications

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“…In line with results from several previous studies, the vast majority of the participants in our study (28/30) had a LES pressure above 15 cmH 2 O during anaesthesia. 30,31 Notably, the two participants with a LES pressure less than 15 cmH 2 O both withstood insufflation during ZEEP ventilation with a PIP of 20 cmH 2 O.…”

Section: Discussionmentioning

confidence: 99%

Effect of positive end-expiratory pressure on gastric insufflation during induction of anaesthesia when using pressure-controlled ventilation via a face mask

Cajander

Edmark

Ahlstrand

et al. 2019

European Journal of Anaesthesiology

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BACKGROUND Face mask ventilation (FMV) during induction of anaesthesia is associated with risk of gastric insufflation that may lead to gastric regurgitation and pulmonary aspiration. A continuous positive airway pressure (CPAP) has been shown to reduce gastric regurgitation. We therefore hypothesised that CPAP followed by FMV with positive end-expiratory pressure (PEEP) during induction of anaesthesia would reduce the risk of gastric insufflation. OBJECTIVE The primary aim was to compare the incidence of gastric insufflation during FMV with a fixed PEEP level or zero PEEP (ZEEP) after anaesthesia induction. A secondary aim was to investigate the effects of FMV with or without PEEP on upper oesophageal sphincter (UES), oesophageal body and lower oesophageal sphincter (LES) pressures. DESIGN A randomised controlled trial. SETTING Single centre, Department of Anaesthesia and Intensive Care, Örebro University Hospital, Sweden. PARTICIPANTS Thirty healthy volunteers. INTERVENTIONS Pre-oxygenation without or with CPAP 10 cmH 2 O, followed by pressure-controlled FMV with either ZEEP or PEEP 10 cmH 2 O after anaesthesia induction. MAIN OUTCOME MEASURES A combined impedance/manometry catheter was used to detect the presence of gas and to measure oesophageal pressures. The primary outcome measure was the cumulative incidence of gastric insufflation, defined as a sudden anterograde increase in impedance of more than 1 kΩ over the LES. Secondary outcome measures were UES, oesophageal body and LES pressures. RESULTS The cumulative incidence of gastric insufflation related to peak inspiratory pressure (PIP), was significantly higher in the PEEP group compared with the ZEEP group (log-rank test P < 0.01). When PIP reached 30 cmH 2 O, 13 out of 15 in the PEEP group compared with five out of 15 had shown gastric insufflation. There was a significant reduction of oesophageal sphincter pressures within groups comparing pre-oxygenation to after anaesthesia induction, but there were no significant differences in oesophageal sphincter pressures related to the level of PEEP. CONCLUSION Contrary to the primary hypothesis, with increasing PIP the tested PEEP level did not protect against but facilitated gastric insufflation during FMV. This result suggests that PEEP should be used with caution after anaesthesia induction during FMV, whereas CPAP during pre-oxygenation seems to be safe. TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT02238691.

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Section: Discussionmentioning

confidence: 99%

Effect of positive end-expiratory pressure on gastric insufflation during induction of anaesthesia when using pressure-controlled ventilation via a face mask

Cajander

Edmark

Ahlstrand

et al. 2019

European Journal of Anaesthesiology

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“…The same group have also shown that the application of positive end-expiratory pressure (PEEP) during anesthesia increases the pressure in the esophagus, which may act as a barrier against regurgitation. 82 It should be noted that the obese patients in these studies did not have active GERD, and although this work is reassuring with respect to the use of laryngeal mask airway devices in similar patients, this cannot be extrapolated to patients with GERD.…”

Section: Upper Gastrointestinal Function and Risk Of Aspiration Of Gamentioning

confidence: 99%

Perioperative management of the severely obese patient: a selective pathophysiological review

Cullen

Ferguson

2012

Can J Anesth/J Can Anesth

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“…The atrioventricular valves (tricuspid and mitral valve) and semilunar valves (pulmonary and aortic valves) are realized by three elements namely inertance (L), resistance (R) and Bernoulli's resistance (B) to address the turbulent flow at orifice (valve). Equation (6) gives the generic expression to calculate pressure drop across any cardiac valve.…”

Section: Cp Model Formulationmentioning

confidence: 99%

“…In addition, stress testing (respiratory maneuvers) is clinically used to detect and evaluate heart diseases because they exhibit good reversibility and are safe to perform. Patients who find it difficult to do exercise on treadmill, patients with coronary artery disease (CAD) and those who suffer from respiratory diseases such as obstructive sleep apnea (OSA) can also perform these maneuvers without much effort to test their CP functionality [6]. Among all respiratory maneuvers, Muller maneuver (MM) is selected for this study because it mimics respiratory pathology OSA in which the absence of breath is realized by strong reduction in intrapleural pressure [5,7].…”

Section: Introductionmentioning

confidence: 99%

Cardiopulmonary model to study interaction hemodynamics in Muller maneuver

Hemalatha

Manivannan

2011

Int. J. Numer. Meth. Biomed. Engng.

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SUMMARYThe Muller maneuver (MM) is a frequently used physiological test in evaluating the cardiopulmonary (CP) interactions along with baroreflex functions in human. In spite of extensive experimental efforts, there is still ambiguity, controversy and disagreement in explaining different aspects of underlying mechanisms during MM. So far a complete comprehension of these mechanisms and the interactions among them is unavailable. In the present study, a CP model with detailed representation of cardiovascular, respiratory and baroreflex system is developed for the purpose of complete, continuous and simultaneous monitoring of all above three systems in MM to explain the underlying mechanisms. Our model incorporates the advantages of various models of all three systems reported separately in literature. Effective coupling is realized by intrapleural pressure between cardiovascular system and respiratory system Baroreflex regulation on cardiovascular system is achieved through vital cardiac parameters such as cardiac duration, contractility and peripheral resistance. Initially, the CP dynamics are tested qualitatively by simulating quiet breathing. Quiet breathing is simulated by perturbing intrapleural pressure in an exponential way from −3.7 to −5.5 mmHg. The quantitative analysis of CP interaction is studied by simulating MM in which strong intrapleural pressure variation is realized. The developed model can predict significant physiological events in individual system dynamics along with their interactions in quiet breathing condition as in literature data. In MM, simulated arterial pressure shows typical characteristic pattern. The quantitative analysis carried out with five different MM simulations shows an increase in LV afterload and decrease in RV preload, which lead to decrease in LV stroke volume. Mean arterial pressure is not significantly changing, however, the pulse pressure reduces significantly that stimulates baroreflex activation in MM. This suggests that arterial baroreflex responds mainly to pulsatile pressure changes compared to mean pressure changes. The right heart hemodynamics are more affected than left heart dynamics in MM. The model results are well supported by the experimental data reported in literature. Therefore, the model can be used as a tool to investigate the CP system dynamics to various normal and abnormal conditions.

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Effects of different respiratory maneuvers on esophageal sphincters in obese patients before and during anesthesia

Cited by 7 publications

References 12 publications

Effect of positive end-expiratory pressure on gastric insufflation during induction of anaesthesia when using pressure-controlled ventilation via a face mask

Effect of positive end-expiratory pressure on gastric insufflation during induction of anaesthesia when using pressure-controlled ventilation via a face mask

Perioperative management of the severely obese patient: a selective pathophysiological review

Cardiopulmonary model to study interaction hemodynamics in Muller maneuver

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