Pfefferkorn Marian D, Croffie Joseph M, Corkins Mark R, Gupta Sandeep K, Fitzgerald Joseph F
Indiana University School of Medicine, James Whitcomb Riley Hospital for Children, Indianapolis, Indiana 46202-5225, USA.
J Pediatr Gastroenterol Nutr. 2004 Mar;38(3):324-7. doi: 10.1097/00005176-200403000-00018.
The study objective was to determine whether the rectoanal inhibitory reflex (RAIR) can be elicited during limited anorectal manometry (ARM) performed under general anesthesia (GA).
In this retrospective study, patients with intractable constipation who underwent ARM under GA from November 1999 to March 2002 were evaluated. Rectal biopsy specimens were examined for the presence of ganglion cells.
Eighty consecutive patients aged 5 months to 16 years were evaluated. Three patients with Hirschsprung disease were excluded from analysis. Ganglion cells were found in rectal biopsy specimens from 76 patients. RAIR was positive in 69 (90%) and negative in 8 (10%). Forty-five patients received preoperative medications: midazolam (n = 36), midazolam + atropine (n = 3), atropine (n = 1), midazolam + glycopyrrolate (n = 3), and glycopyrrolate (n = 2). Different combinations of general anesthetic medications were used. Ten patients received neuromuscular blockers. The use of preoperative midazolam or atropine did not affect the presence or absence of RAIR; however, the proportion of patients with negative RAIR was higher in those receiving glycopyrrolate (P = 0.007) than in those receiving other medications. There was no significant difference in the effect of the general anesthetic agents or neuromuscular blockers used on the presence or absence of RAIR.
The rectoanal inhibitory reflex in children can be elicited even when anorectal manometry is performed under general anesthesia. Glycopyrrolate, an anticholinergic, appears to inhibit the demonstration of the RAIR.
本研究的目的是确定在全身麻醉（GA）下进行有限的肛门直肠测压（ARM）时是否能引出直肠肛门抑制反射（RAIR）。
在这项回顾性研究中，对1999年11月至2002年3月期间在GA下接受ARM的顽固性便秘患者进行了评估。检查直肠活检标本中是否存在神经节细胞。
对80例年龄在5个月至16岁的连续患者进行了评估。3例患有先天性巨结肠病的患者被排除在分析之外。在76例患者的直肠活检标本中发现了神经节细胞。RAIR阳性69例（90%），阴性8例（10%）。45例患者接受了术前用药：咪达唑仑（n = 36）、咪达唑仑 + 阿托品（n = 3）、阿托品（n = 1）、咪达唑仑 + 格隆溴铵（n = 3）和格隆溴铵（n = 2）。使用了不同组合的全身麻醉药物。10例患者接受了神经肌肉阻滞剂。术前使用咪达唑仑或阿托品不影响RAIR的有无；然而，接受格隆溴铵的患者中RAIR阴性的比例高于接受其他药物的患者（P = 0.007）。所使用的全身麻醉剂或神经肌肉阻滞剂对RAIR有无的影响无显著差异。
即使在全身麻醉下进行肛门直肠测压，儿童的直肠肛门抑制反射也能引出。抗胆碱能药物格隆溴铵似乎会抑制RAIR的表现。
