The effects of premedication drugs on the lower oesophageal high pressure zone and reflux status of rhesus monkeys and man.

Abstract

SUMMARY Thirty-five human volunteers and eight Rhesus monkeys were studied with standard gastrooesophageal manometric techniques and their reflux status was evaluated with a pH probe placed in the lower oesophagus. Morphine sulphate, pethidine hydrochloride, or diazepam was given intravenously until drowsiness was induced.The manometric and pH studies were repeated. All three drugs decreased the lower oesophageal high pressure zone and increased the probability of reflux in both monkeys and man. These findings are relevant in the preparation of patients for surgery since gastrooesophageal reflux and pulmonary aspiration may be a problem in the pre-and postoperative phases.

Effect of intravenous diazepam on human lower oesophageal sphincter pressure under controlled double blind crossover conditions.

“…F. Forster, H. Kohier, K. Ewe, and J. Krieglstein Effect of intravenous diazepam on human lower oesophageal sphincter pressure 67 dictions in their observations and our results. As in our study the dose range applied by Hall et al (1975) (approximately 5 and 10 mg diazepam in a subject weighing 70 kg) did not lower the sphincter pressure but rather increased it, our investigation was extended. In order to assess a possible immediate effect developing within the first few minutes or later than 50 minutes after the injection, which would have been missed in the first study (group I), studies in group II were carried out taking these factors into account.…”

“…According to these studies atropine, morphine sulphate, pethidine hydrochloride, and promethazine reduce and triflupromazine hydrochloride increases lower oesophageal sphincter pressure. The first report on the effect of diazepam on the gastro-oesophageal junction was published by Hall et al (1975) who observed a reduction in sphincter pressures after the administration of 2-5 to 10 mg diazepam intravenously in an uncontrolled study. These results are in contrast to the results of the present study.…”

“…The original goal of the present study was to evaluate the effect of 70 and 140 ug/kg diazepam intravenously on lower oesophageal sphincter pressure in 12 subjects, a dose range corresponding to that administered by Hall et al (1975). But, as no significant changes in lower oesophageal spincter pressures could be observed after these doses in a 50 minute period (group I), the studywas extended to six further subjects (group II) to investigate the effect of a higher dose (280 ug/kg) for a longer period of time (120 minutes).…”

“…Therefore, the effect of drugs which lower the sphincter pressure are of great clinical interest because of the increased risk of gastro-oesophageal reflux. Hall et al (1975) reported significant reductions in lower oesophageal sphincter pressures and an increased rate of gastrooesophageal reflux in man after intravenous administration of 2.5 to 10 mg diazepam. They concluded that an increased risk of regurgitation and pulmonary aspiration should be taken into account after the administration of diazepam for premedication or postoperative sedation, especially in patients known to experience gastro-oesophageal reflux.…”

“…Therefore, the effect of drugs which lower the sphincter pressure are of great clinical interest because of the increased risk of gastro-oesophageal reflux. Hall et al (1975) Received for publication 25 July 1978 and our results based upon a pilot study, the present study was initiated to determine the effect of various doses of diazepam on lower oesophageal sphincter pressure in man in a controlled double-blind crossover study. …”