Department of Anesthesiology and Intensive Care, Örebro Univerity Hospital, Sweden.
Acta Anaesthesiol Scand. 2011 Oct;55(9):1098-105. doi: 10.1111/j.1399-6576.2011.02517.x. Epub 2011 Sep 7.
The pressure in the lower esophageal sphincter (LES) is partly dependent on striated muscles derived from the crural portion of the diaphragm. The effect of neuromuscular blockade on the integrity of the esophagogastric junction is not well studied. We conducted a prospective interventional study to determine the effect of rocuronium on the barrier pressure (LES pressure - intragastric pressure) of the esophagogastric junction. We also studied the effect of positive pressure ventilation on the barrier pressure after neuromuscular blockade with rocuronium.
Fourteen patients classified as American Society of Anesthesiologists classification system (ASA) I or II (aged 18-75 years) who presented for elective surgery (11 cholecystectomy, 3 inguinal hernia) participated in the study. Esophageal manometry was performed during anesthetization with propofol, fentanyl, and sevoflurane. The LES pressure was studied prior to anesthesia, after anesthesia induction during spontaneous breathing with laryngeal mask airway, after administration of rocuronium (0.6 mg/kg), and during positive pressure ventilation.
Muscle relaxation with rocuronium showed no significant changes in barrier pressure when comparing the pressure immediately before rocuronium administration with the pressure obtained after rocuronium administration at the time point of 0% train-of-four (TOF). Conversion to positive pressure ventilation did not change the barrier pressure with inspiration or expiration. The greatest decrease in barrier pressure was measured after inducing anesthesia when comparing pressures during inspiration (P < 0.01).
Neuromuscular blockade with rocuronium and conversion from spontaneous breathing to positive pressure ventilation does not decrease the barrier pressure during anesthesia induction.
食管下括约肌（LES）的压力部分依赖于源自膈脚的横纹肌。神经肌肉阻滞对食管胃连接完整性的影响尚未得到很好的研究。我们进行了一项前瞻性干预研究，以确定罗库溴铵对食管胃连接的屏障压力（LES 压力-胃内压力）的影响。我们还研究了罗库溴铵神经肌肉阻滞后正压通气对屏障压力的影响。
14 名 ASA 分级 I 或 II 级（18-75 岁）的择期手术患者（胆囊切除术 11 例，腹股沟疝 3 例）参与了这项研究。在使用丙泊酚、芬太尼和七氟醚麻醉期间进行食管测压。在麻醉前、麻醉诱导期间使用喉罩通气时、给予罗库溴铵（0.6mg/kg）后以及正压通气期间研究 LES 压力。
罗库溴铵肌松时，在 0%四成串（TOF）时，与罗库溴铵给药前的压力相比，即刻给药后即刻的屏障压力没有显著变化。转为正压通气不会改变吸气或呼气时的屏障压力。与麻醉诱导期间的压力相比，最大的屏障压力下降发生在诱导麻醉时（P<0.01）。
罗库溴铵神经肌肉阻滞和从自主呼吸转为正压通气不会降低麻醉诱导期间的屏障压力。
