Cricoid Cartilage Pressure Decreases Lower Esophageal Sphincter Tone

1997 ◽  
Vol 86 (1) ◽  
pp. 7-9 ◽  
Author(s):  
Jean-Pierre Tournadre ◽  
Dominique Chassard ◽  
Khalid R. Berrada ◽  
Paul Bouletreau
Keyword(s):  
Lower Esophageal Sphincter ◽  
Cricoid Pressure ◽  
Cricoid Cartilage ◽  
Pulmonary Aspiration ◽  
Human Volunteers ◽  
Gastric Pressure ◽  
Manometric Method ◽  
Esophageal Sphincter ◽  
American Society ◽  
American Society Of Anesthesiologists

Background Cricoid cartilage pressure induced to prevent pulmonary aspiration from regurgitation of gastric contents has been recommended, and its efficacy requires a force greater than 40 Newtons. For regurgitation to occur, both an increase in gastric pressure and relaxation of the lower esophageal sphincter (LES) are necessary. However, the effect of cricoid cartilage pressure on the LES is unknown. This study evaluated the effects of cricoid cartilage pressure on LES in human volunteers. Methods Lower esophageal sphincter and esophageal barrier pressures (which equals LES pressure-gastric pressure) were measured using a manometric method in eight unanesthetized volunteers (4 men, 4 women) classified as American Society of Anesthesiologists physical status 1. The force applied to the cricoid cartilage was measured continuously, and LES pressure was recorded at a cricoid force of 20 and 40 Newtons. Results Cricoid pressure decreased LES pressure from 24 +/- 3 mmHg to 15 +/- 4 mmHg at a force of 20 Newtons (P < 0.05) and to 12 +/- 4 mmHg with a force of 40 Newtons (P < 0.01). Conclusions These findings may explain the occurrence of pulmonary aspiration before tracheal intubation despite application of cricoid cartilage pressure.

scholarly journals Metoclopramide Does Not Attenuate Cricoid Pressure–induced Relaxation of the Lower Esophageal Sphincter in Awake Volunteers

2008 ◽  
Vol 109 (5) ◽  
pp. 806-810 ◽  
Author(s):  
M Ramez Salem ◽  
Keith W. Bruninga ◽  
Jyothi Dodlapatii ◽  
Ninos J. Joseph
Keyword(s):  
Lower Esophageal Sphincter ◽  
No Value ◽  
Cricoid Pressure ◽  
Pressure Application ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Human Volunteers ◽  
Baseline Values ◽  
Esophageal Sphincter ◽  
Made In

Background The authors examined the influence of metoclopramide on cricoid pressure-induced relaxation of the lower esophageal sphincter (LES) in awake human volunteers. Methods With local institutional review board approval, measurements of LES and intragastric pressures were made in 10 consenting volunteers before cricoid pressure application, during 15 s of cricoid pressure application, and after release of cricoid pressure. The measurements were repeated after 0.15 mg/kg intravenous metoclopramide. Cricoid pressure was applied by one investigator trained to consistently apply a force of 44 N. Results Cricoid pressure resulted in immediate decrease in LES and barrier pressures from 14.1 +/- 2.9 mmHg to 3.2 +/- 3.7 mmHg and from 9.6 +/- 3.4 mmHg to -1.8 +/- 2.9 mmHg, respectively. These pressures promptly returned to baseline values after release of cricoid pressure. LES and barrier pressures increased after metoclopramide from 14.5 +/- 3.1 to 19.6 +/- 4.7 mmHg and from 10.2 +/- 3.6 to 14.1 +/- 5.5 mmHg, respectively. Cricoid pressure applied after metoclopramide resulted in immediate decreases in LES and barrier pressures to levels comparable to cricoid pressure before metoclopramide, but immediately returned to precricoid values after release of pressure. Conclusions The current investigation demonstrates that cricoid pressure reflexly decreases LES tone and barrier pressure in awake subjects. Although metoclopramide increased LES and barrier pressures, it did not attenuate cricoid pressure-induced relaxation of the LES and barrier pressures and thus seems to have no value in preventing gastroesophageal reflux during cricoid pressure. Metoclopramide may be useful in preventing reflux when there is need to release or discontinue cricoid pressure.

scholarly journals A human model of restricted upper esophageal sphincter opening and its pharyngeal and UES deglutitive pressure phenomena

2016 ◽  
Vol 311 (1) ◽  
pp. G84-G90 ◽  
Author(s):  
Hongmei Jiao ◽  
Ling Mei ◽  
Tarun Sharma ◽  
Mark Kern ◽  
Patrick Sanvanson ◽  
...  
Keyword(s):  
Contractile Function ◽  
Cricoid Pressure ◽  
Cricoid Cartilage ◽  
Oropharyngeal Dysphagia ◽  
Upper Esophageal Sphincter ◽  
The Other ◽  
Human Model ◽  
Esophageal Sphincter ◽  
Ues Opening ◽  
High Pressure Zone

Oropharyngeal dysphagia due to upper esophageal sphincter (UES) dysfunction is commonly encountered in the clinical setting. Selective experimental perturbation of various components of the deglutitive apparatus can provide an opportunity to improve our understanding of the swallowing physiology and pathophysiology. The aim is to characterize the pharyngeal and UES deglutitive pressure phenomena in an experimentally induced restriction of UES opening in humans. We studied 14 volunteers without any dysphagic symptoms (7 men, 66 ± 11 yr) but with various supraesophageal reflux symptoms. To induce UES restriction, we used a handmade device that with adjustment could selectively apply 0, 20, 30, or 40 mmHg pressure perpendicularly to the cricoid cartilage. Deglutitive pharyngeal and UES pressure phenomena were determined during dry and 5- and 10-ml water swallows × 3 for each of the UES perturbations. External cricoid pressure against the UES resulted in a significant increase in hypopharyngeal intrabolus pressure and UES nadir deglutitive relaxation pressure for all tested swallowed volumes ( P < 0.05). Application of external cricoid pressure increased the length of the UES high pressure zone from 2.5 ± 0.2 to 3.1 ± 0.2, 3.5 ± 0.1, and 3.7 ± 0.1 cm for 20, 30, and 40 mmHg cricoid pressure, respectively ( P < 0.05). External cricoid pressure had no significant effect on pharyngeal peristalsis. On the other hand, irrespective of external cricoid pressure deglutitive velopharyngeal contractile integral progressively increased with increased swallowed volumes ( P < 0.05). In conclusion, acute experimental restriction of UES opening by external cricoid pressure manifests the pressure characteristics of increased resistance to UES transsphincteric flow observed clinically without affecting the pharyngeal peristaltic contractile function.

scholarly journals Pulmonary Aspiration of Gastric Contents: A Closed Claims Analysis

2021 ◽  
Author(s):  
Mark A. Warner ◽  
Karen L. Meyerhoff ◽  
Mary E. Warner ◽  
Karen L. Posner ◽  
Linda Stephens ◽  
...  
Keyword(s):  
Anesthetic Management ◽  
Pulmonary Aspiration ◽  
Anesthesia Care ◽  
Inclusion Criteria ◽  
Gastrointestinal Obstruction ◽  
Malpractice Claims ◽  
Gastric Contents ◽  
American Society ◽  
Closed Claims ◽  
American Society Of Anesthesiologists

Background Perioperative pulmonary aspiration of gastric contents has been associated with severe morbidity and death. The primary aim of this study was to identify outcomes and patient and process of care risk factors associated with gastric aspiration claims in the Anesthesia Closed Claims Project. The secondary aim was to assess these claims for appropriateness of care. The hypothesis was that these data could suggest opportunities to reduce either the risk or severity of perioperative pulmonary aspiration. Methods Inclusion criteria were anesthesia malpractice claims in the American Society of Anesthesiologists Closed Claims Project that were associated with surgical, procedural, or obstetric anesthesia care with the year of the aspiration event 2000 to 2014. Claims involving pulmonary aspiration were identified and assessed for patient and process factors that may have contributed to the aspiration event and outcome. The standard of care was assessed for each claim. Results Aspiration of gastric contents accounted for 115 of the 2,496 (5%) claims in the American Society of Anesthesiologists Closed Claims Project that met inclusion criteria. Death directly related to pulmonary aspiration occurred in 66 of the 115 (57%) aspiration claims. Another 16 of the 115 (14%) claims documented permanent severe injury. Seventy of the 115 (61%) patients who aspirated had either gastrointestinal obstruction or another acute intraabdominal process. Anesthetic management was judged to be substandard in 62 of the 115 (59%) claims. Conclusions Death and permanent severe injury were common outcomes of perioperative pulmonary aspiration of gastric contents in this series of closed anesthesia malpractice claims. The majority of the patients who aspirated had either gastrointestinal obstruction or acute intraabdominal processes. Anesthesia care was frequently judged to be substandard. These findings suggest that clinical practice modifications to preoperative assessment and anesthetic management of patients at risk for pulmonary aspiration may lead to improvement of their perioperative outcomes. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Human lower esophageal sphincter pressure response to increased intra-abdominal pressure

1990 ◽  
Vol 258 (4) ◽  
pp. G624-G630 ◽  
Author(s):  
R. K. Mittal ◽  
M. Fisher ◽  
R. W. McCallum ◽  
D. F. Rochester ◽  
J. Dent ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Esophagogastric Junction ◽  
Tonic Contraction ◽  
Pressure Response ◽  
Abdominal Pressure ◽  
Abdominal Compression ◽  
Gastric Pressure ◽  
Straight Leg Raising ◽  
Esophageal Sphincter ◽  
Crural Diaphragm

We studied the effects of increased intra-abdominal pressure on the lower esophageal sphincter (LES) pressure in 15 healthy subjects. The role of the diaphragm in the genesis of LES pressure during increased intra-abdominal pressure was determined by measuring diaphragm electromyogram (EMG). The latter was recorded using bipolar intraesophageal platinum electrodes that were placed on the nonpressure sensing surface of the sleeve device. We also measured the LES pressure response to increased intra-abdominal pressure during inhibition of the smooth muscles of the LES by intravenous atropine (12 micrograms/kg). Straight-leg raising and abdominal compression were used to increase intra-abdominal pressure. Our results show that the increase in LES pressure during straight-leg raising is greater than the increase in gastric pressure. During abdominal compression, the rate of LES pressure increase is faster than that of the gastric pressure, suggesting an active contraction at the esophagogastric junction. The increase in LES pressure during periods of increased intra-abdominal pressure is associated with a tonic contraction of the crural diaphragm as demonstrated by EMG recording. Atropine inhibited the resting LES pressure by 50-70% in each subject but had no effect either on the peak LES pressure attained during increased intra-abdominal pressure or tonic crural diaphragm EMG. We conclude that 1) there is an active contraction at the esophagogastric junction during periods of increased intra-abdominal pressure and 2) tonic contraction of the crural diaphragm is a mechanism for this LES pressure response.

Pulmonary Aspiration

2018 ◽  
pp. 168-173
Keyword(s):  
Clinical Significance ◽  
Postoperative Period ◽  
Perioperative Period ◽  
Clinical Findings ◽  
Pulmonary Aspiration ◽  
Surgical Patients ◽  
Physical Status ◽  
Emergency Procedures ◽  
American Society ◽  
American Society Of Anesthesiologists

This case focuses on pulmonary aspirations during the perioperative period by asking the question: What is the incidence and clinical significance of pulmonary aspiration during the perioperative period based on the predictive potential of common clinical findings? This study showed that pulmonary aspiration among surgical patients was associated with increasing American Society of Anesthesiologists (ASA) physical status and emergency procedures. Patient with clinically apparent pulmonary aspiration who do not develop signs or symptoms within 2 hours in the immediate postoperative period are unlikely to have respiratory sequelae.

Effect of cholecystokinin-octapeptide on opossum lower esophageal sphincter

1980 ◽  
Vol 239 (3) ◽  
pp. G230-G235 ◽  
Author(s):  
J. Dent ◽  
W. J. Dodds ◽  
W. J. Hogan ◽  
R. C. Arndorfer ◽  
B. C. Teeter
Keyword(s):  
Smooth Muscle ◽  
Lower Esophageal Sphincter ◽  
Direct Action ◽  
Esophageal Pressure ◽  
Smooth Muscle Contraction ◽  
Pressor Effect ◽  
Intragastric Pressure ◽  
Longitudinal Smooth Muscle ◽  
Gastric Pressure ◽  
Esophageal Sphincter

We evaluated the action of cholecystokini-octapeptide (CCK-OP) on lower esophageal sphincter (LES) pressure in the opossum. LES pressure was recorded by an infused sleeve device that straddled the sphincter, whereas intraluminal esophageal pressure and gastric pressure were recorded via conventional manometric catheters. Progressive intravenous pulse doses of CCK-OP caused 1) graded increases in LES pressure, 2) circular and longitudinal smooth muscle contraction in esophageal body, and 3) mild increases in intragastric pressure. Pressor effect of CCK-OP on the LES was weakly antagonized by tetrodotoxin (TTX), but not by atropine, phentolamine, or pyrilamine. TTX antagonism of CCK-OP appeared to be nonspecific because TTX also partially antagonized LES contractions induced by pentagastrin, substance P, and bethanechol. We conclude that CCK-OP at doses that cause LES relaxation in other species induces LES contraction in the opossum. This pressor effect appears to be elicited by a direct action of the hormone on LES smooth muscle.

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