Influence of General Anaesthesia on Ano‐rectal Manometry in Healthy Children

Frenckner, Björn; Molander, Marie-Louise

doi:10.1111/j.1651-2227.1979.tb04967.x

Cited by 19 publications

(7 citation statements)

References 13 publications

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“…A total of 27 patients were included in the study. The mean age was 9.2 (4–18) years, most of whom were male (63%). The main indication for testing was medical refractory constipation in 24 (88%).…”

Section: Resultsmentioning

confidence: 99%

Can Propofol Be Used to Assess the Presence of the Rectoanal Inhibitory Reflex During Anorectal Manometry Studies?

Arbizu

Amicangelo

Rodriguez

et al. 2021

J. pediatr. gastroenterol. nutr.

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Objectives: To study changes in intra-anal pressure (IAP) and characteristics of the rectoanal inhibitory reflex (RAIR) during anorectal manometry (ARM) in patients undergoing anesthesia induction with propofol. Methods: Prospective study in which ARM was performed at baseline while patients were awake and repeated after propofol-induced anesthesia. We studied IAP and the presence and characteristics of the RAIR before and after propofol. Results: A total of 27 patients were included (63% male; 9.2 years). Three patients had obstructive symptoms after Hirschsprung disease repair (HSCR), and 24 had intractable constipation. At baseline, the RAIR was present on 21 of 27 patients and absent on 6 of 27. Of the six patients with an absent RAIR, it remained absent in four of six (three known HSCR, and one new diagnosis of IAS achalasia), and two of six had a normal RAIR during propofol. Therefore, RAIR was present in all patients with constipation. The mean resting IAP was significantly lower after propofol. The percentage of IAS relaxation after lower balloon volume inflations was significantly higher during propofol (P < 0.05). No difference was observed over the latency time or the total relaxation time after propofol. Conclusions: Propofol can be used to assess the presence of the RAIR during ARM in children who are uncooperative and undergoing other procedures under anesthesia. On the other hand, propofol significantly reduces the resting IAP and increases the percentage of internal anal sphincter relaxation after balloon distention. These findings may impact the interpretation to decide if an intervention is needed, or if there is a possible spinal neuropathy.

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Section: Resultsmentioning

confidence: 99%

Can Propofol Be Used to Assess the Presence of the Rectoanal Inhibitory Reflex During Anorectal Manometry Studies?

Arbizu

Amicangelo

Rodriguez

et al. 2021

J. pediatr. gastroenterol. nutr.

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“…Rectal volume, resting anal pressure and the presence of recto‐anal inhibition reflex were recorded and the sensation/perception of rectal filling was registered. The results were related to reference values for pressures given by Frenckner and Molander 19, and for volumes given by Borg et al 20 and Sixt (pers. comm., 2005).…”

Section: Methodsmentioning

confidence: 99%

Tap‐water enema for children with myelomeningocele and neurogenic bowel dysfunction

Mattsson

Gladh

2006

Acta Paediatrica

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Aim: To evaluate the outcome of transrectal irrigation (TRI) using clean tap water without salt in children with myelomeningocele and neurogenic bowel problems. Methods: 40 children (21 boys and 19 girls; aged 10 mo to 11 y) with myelomeningocele and neurogenic bowel dysfunction were treated with TRI given by a stoma cone irrigation set daily or every second day. A questionnaire on the effects on faecal incontinence, constipation and self‐management was completed by the parents, 4 mo–8 y (median 1.5 y) after start. Effects on rectal volume, anal sphincter pressure and plasma sodium were evaluated before and after the start of irrigation. Results: At follow‐up, 35 children remained on TRI, four had received appendicostomy, while one defecated normally. For all children but five (35/40; 85%) the procedure worked satisfactorily, but a majority found the procedure very time consuming and only one child was able to perform it independently. All children were free of constipation; most (35/40) were also anal continent. Rectal volume and anal sphincter pressure improved, while plasma sodium values remained within the normal range. Conclusion: Transrectal irrigation with tap water is a safe method to resolve constipation and faecal incontinence in children with myelomeningocele and neurogenic bowel dysfunction, but it does not help children to independence at the toilet.

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“…The IAS is made of smooth muscle derived from the circular muscle layer of the rectum, forming a ring that, if contracted, encloses the anal canal circumferentially in a spiral orientation and contributes to the majority of the anal pressure at rest (70%–85%) ( 10 , 11 ). The IAS is innervated by both excitatory and inhibitory motor neurons which receive neural input from intramural plexuses and autonomic nerves in the lesser pelvis ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

“…Although their contribution to anal canal resting pressure is minimal, both are able to contract voluntarily and involuntarily to maintain continence ( 15 , 16 ). Their voluntary contractions are regulated by the pudendal nerve which originates from the second to fourth sacral roots ( 10 , 17 ). They seem to mainly play a role in sudden straining, therefore their contraction may play a role during sudden inflation of the rectal balloon during ARM ( 18 , 19 ).…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Anorectal Manometry to Detect the Rectoanal Inhibitory Reflex in Children: Awake Versus Under General Anesthesia

Baaleman

Mishra

Koppen

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: Our objective was to investigate if there is a difference in the detection of the rectoanal inhibitory reflex (RAIR) when an anorectal manometry (ARM) is performed awake or under general anesthesia. Methods: A retrospective review of ARM studies was performed to identify children who had undergone ARMs both while awake and under general anesthesia. We compared ARM outcomes including the detection of the RAIR and anal canal resting pressure. Results: Thirty-four children had received ARMs both while awake and under general anesthesia (53% female, median age at first ARM 7.5 years [range 3–18 years]). In 9 of 34 (26%) children the RAIR was solely identified during ARM under general anesthesia and not during ARM while awake. In 6 of 9 (66%) this was unrelated to the balloon volumes used during balloon inflations. In 4 of 34 (12%) children, assessment of the RAIR was inconclusive during ARM under general anesthesia due to too low, or loss of anal canal pressure. In 2 of those children, ARMs while awake showed presence of a RAIR. Anal canal resting pressures were higher during ARM while awake versus ARM under general anesthesia (median 70 [interquartile range, IQR 59–85] vs 46 mmHg [IQR 36–65] respectively, P < 0.001). Conclusions: General anesthesia may affect the detection of a RAIR in 2 ways. On the one hand, it may facilitate better visualization in children in whom a RAIR could not be visualized while awake. On the other hand, it may cause a loss of anal canal pressure resulting in an inconclusive test result.

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Influence of General Anaesthesia on Ano‐rectal Manometry in Healthy Children

Cited by 19 publications

References 13 publications

Can Propofol Be Used to Assess the Presence of the Rectoanal Inhibitory Reflex During Anorectal Manometry Studies?

Can Propofol Be Used to Assess the Presence of the Rectoanal Inhibitory Reflex During Anorectal Manometry Studies?

Tap‐water enema for children with myelomeningocele and neurogenic bowel dysfunction

Accuracy of Anorectal Manometry to Detect the Rectoanal Inhibitory Reflex in Children: Awake Versus Under General Anesthesia

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