Abstract
Purpose
Previous studies have shown a decrease of lower oesophageal sphincter (LOS) tone during stimulation of the upper oesophageal sphincter. Therefore, we hypothesized that during anaesthesia, cricoid pressure could result in a decrease in LOS pressure.
Methods
The LOS and oesophageal barrier pressures (BrP = LOSP minus gastric pressure) were obtained in 11 anaesthetized pigs with intraabdominal pressure of 15 mmHg using a manometric method (perfused catheters) before and during firm application of cricoid pressure. Reflux was assessed with concomittant recording of the lower oesophageal pH.
Results
Cricoid pressure decreased LOSP from 31.0 ± 14.5 mmHg to 26.1 ± 12.7 mmHg (P < 0.001) leading to a 35% reduction of oesophageal barrier pressure (9 ± 10.3 mmHg vs 13.7 ± 12.4 mmHg; P< 0.001). No episodes of reflux were recorded.
Conclusions
This study shows that cricoid pressure decreases LOS tone in anaesthetized pigs. Although no gastrooesophageal reflux was recorded, this study suggests that, if cricoid pressure does not completely occlude the oesophagus, the decrease of oesophageal barrier pressure induced could favour the appearance of pulmonary aspiration.
Résumé
Objectif
La stimulation du sphincter supérieur de l’oesophage (SSO) entraîne une diminution du tonus du sphincter inférieur de l’oesophage (SIO). Le but de cette étude a été d’évaluer les effets de la pression cricoïdienne (manoeuvre de Sellick) sur la pression du SIO.
Méthode
Chez 11 porcs anesthésiés à pression intraabdominale élevée (pneumopéritoine de 15 mmHg), la pression du sphincter inférieur de l’oesophage (PSIO) et la pression de barrière (BrP = PSIO moins pression gastrique) ont été enregistrées par une méthode manométrique (catheter perfusé), avant et pendant l’application de la manoeuvre de Sellick (pression cricoïdienne en regard du SSO). La survenue d’un reflux a été évaluée par la surveillance en continu du pH de l’oesophage inférieur.
Résultats
La pression cricoïdienne diminuait la PSIO de 31.0 ± 14.5 mmHg à 26.1 ± 12.7 mmHg (P < 0.001) entraînant une réduction de 35 % de la pression de barrière: 9 ± 10.3 mmHg versus 13.7 ± 12.4 mmHg; P < 0.001. Aucun reflux n’a été enregistré pendant la pression cricoïdienne.
Conclusions
Cette étude montre que la pression cricoïdienne entraîne une baisse de la pression du SIO et de la pression de barrière chez le porc anesthésié. Malgré qu ’aucun reflux n’ait été enregistré, ces résultats suggèrent qu’une incompétence du SIO avec risque d’inhalation pulmonaire peut survenir si la lumière oesophagienne n’est pas complétement obturèe par la compression cricoïdienne.
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Chassard, D., Tournadre, J.P., Berrada, K.R. et al. Cricoid pressure decreases lower oesophageal sphincter tone in anaesthetized pigs. Can J Anaesth 43, 414–417 (1996). https://doi.org/10.1007/BF03011724
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DOI: https://doi.org/10.1007/BF03011724