Document Detail

Barrier pressure of the oesophagogastric junction during propofol induction with and without alfentanil: a double-blind, randomised, crossover study in volunteers.
MedLine Citation:
PMID:  22146614     Owner:  NLM     Status:  MEDLINE    
CONTEXT: Practice varies regarding the use of opioids during rapid sequence induction. Controversy exists as to whether opioids may increase the risk of pulmonary aspiration by decreasing the barrier pressure (lower oesophageal sphincter-intragastric pressure).
OBJECTIVES: To evaluate the effects of adding alfentanil during anaesthesia induction with propofol with respect to the barrier pressure in the oesophagogastric junction.
PARTICIPANTS AND SETTING: Seventeen healthy volunteers (11 men and six women) participated in a double-blind, randomised, crossover trial at the University Hospital in Orebro, Sweden.
INTERVENTIONS AND OUTCOME MEASURES: The volunteers were anaesthetised on two different occasions, randomly assigned to receive either alfentanil 20 μg kg(-1) or an equivalent amount of isotonic saline, administered intravenously, 1 min before induction with propofol 2 mg kg(-1). One minute after propofol administration, a cricoid pressure of 30 N was applied. The primary outcome was the difference in the change in barrier pressure between the alfentanil and the placebo occasion 1 min after propofol administration. The secondary outcomes were differences in the changes in barrier pressure 1 min after alfentanil or placebo administration and during ongoing cricoid pressure application.
RESULTS: There were no statistically significant differences in barrier pressure, at any time point, between anaesthesia induction with alfentanil and propofol compared with induction with placebo and propofol. The barrier pressure never decreased to less than 2.4 mmHg in any volunteer.
CONCLUSION: Our study showed no increased risk regarding the integrity of the gastro-oesophageal junction when alfentanil is added during an induction with propofol in volunteers. This supports the practice of adding opioids as adjuvants during rapid sequence induction.
Rebecca Ahlstrand; Sven-Egron Thörn; Anette Dahlkvist; Magnus Wattwil; Anders Magnuson
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  European journal of anaesthesiology     Volume:  29     ISSN:  1365-2346     ISO Abbreviation:  Eur J Anaesthesiol     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2011-12-07     Completed Date:  2012-04-16     Revised Date:  2012-09-10    
Medline Journal Info:
Nlm Unique ID:  8411711     Medline TA:  Eur J Anaesthesiol     Country:  England    
Other Details:
Languages:  eng     Pagination:  28-34     Citation Subset:  IM    
Department of Anaesthesia and Intensive Care, Örebro University Hospital, Orebro, Sweden.
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MeSH Terms
Alfentanil / administration & dosage*,  adverse effects
Analgesics, Opioid / administration & dosage*,  adverse effects
Analysis of Variance
Anesthetics, Intravenous / administration & dosage*,  adverse effects
Cross-Over Studies
Double-Blind Method
Esophagogastric Junction / drug effects*
Hospitals, University
Propofol / administration & dosage*,  adverse effects
Respiratory Aspiration / etiology
Young Adult
Reg. No./Substance:
0/Analgesics, Opioid; 0/Anesthetics, Intravenous; 2078-54-8/Propofol; 71195-58-9/Alfentanil

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