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Minerva Anestesiologica Sep 2019The performance of a precise and safe peripheral nerve blockade (PNB) can currently rely on the aid of the ultrasounds and nerve stimulators. The injection pressure... (Review)
Review
The performance of a precise and safe peripheral nerve blockade (PNB) can currently rely on the aid of the ultrasounds and nerve stimulators. The injection pressure monitoring may be beneficial to perform a safer procedure. This review focuses on the pressures measured during PNB among studies conducted on animal, and human models. From a deep research among the PubMed/MEDLINE database for all reports published in English between January 2004 and November 2018, we selected 15 original papers. We excluded those that were reviews, case-reports, recommendations and correspondences, that did not match with object of our study. We highlighted the available systems for monitoring injection pressures and classified the reports on the basis of the model used for the respective study (animals, humans, in vitro). Intraneural injections were associated with lower pressures than perineural ones. High injection pressures registered at the needle tip were associated with an increased risk of nerve damage. To date, a precise cut-off pressure value has not yet emerged from the literature for a safe PNBs, but based on the recent literature, it can be stated that the threshold of 15 psi is an acceptable value under which a perineural injection can be performed during a PNB to achieve a safer procedure. So it is desirable to make further studies in order to assess them. In the future, the monitoring of the pressure could allow the use of a minimal quantity of anesthetic, empowering the safety of the nerve blocks. Moreover, the sensitive system should not be invasive and it should not hinder the job of the anesthetists.
Topics: Animals; Cadaver; Humans; In Vitro Techniques; Infusion Pumps; Injections; Intraoperative Complications; Mammals; Manometry; Needles; Nerve Block; Peripheral Nerve Injuries; Syringes; Ultrasonography, Interventional
PubMed: 31124620
DOI: 10.23736/S0375-9393.19.13518-3 -
Current Gastroenterology Reports Aug 2020In the absence of mucosal or structural disease, the aim of investigating the oesophagus is to provide clinically relevant measurements of function that can explain the... (Review)
Review
PURPOSE OF REVIEW
In the absence of mucosal or structural disease, the aim of investigating the oesophagus is to provide clinically relevant measurements of function that can explain the cause of symptoms, identify pathology and guide effective management. One of the most notable recent advances in the field of oesophageal function has been high-resolution manometry (HRM). This review explores how innovation in HRM has progressed and has far from reached a plateau.
RECENT FINDINGS
HRM technology, methodology and utility continue to evolve; simple additions to the swallow protocol (e.g. eating and drinking), shifting position, targeting symptoms and adding impedance sensors to the HRM catheter have led to improved diagnoses, therapeutic decision-making and outcomes. Progress in HRM persists and shows little sign of abating. The next iteration of the Chicago Classification of motor disorders will highlight these advances and will also identify opportunities for further research and innovation.
Topics: Deglutition; Electric Impedance; Esophageal Motility Disorders; Humans; Manometry; Patient Positioning
PubMed: 32767186
DOI: 10.1007/s11894-020-00787-x -
The American Journal of Gastroenterology Aug 2023High-resolution manometry (HRM) and functional lumen imaging probe (FLIP) are primary and/or complementary diagnostic tools for the evaluation of esophageal motility. We...
INTRODUCTION
High-resolution manometry (HRM) and functional lumen imaging probe (FLIP) are primary and/or complementary diagnostic tools for the evaluation of esophageal motility. We aimed to assess the interrater agreement and accuracy of HRM and FLIP interpretations.
METHODS
Esophageal motility specialists from multiple institutions completed the interpretation of 40 consecutive HRM and 40 FLIP studies. Interrater agreement was assessed using intraclass correlation coefficient (ICC) for continuous variables and Fleiss' κ statistics for nominal variables. Accuracies of rater interpretation were assessed using the consensus of 3 experienced raters as the reference standard.
RESULTS
Fifteen raters completed the HRM and FLIP studies. An excellent interrater agreement was seen in supine median integral relaxation pressure (ICC 0.96, 95% confidence interval 0.95-0.98), and a good agreement was seen with the assessment of esophagogastric junction (EGJ) outflow, peristalsis, and assignment of a Chicago Classification version 4.0 diagnosis using HRM (κ = 0.71, 0.75, and 0.70, respectively). An excellent interrater agreement for EGJ distensibility index and maximum diameter (0.91 [0.90-0.94], 0.92 [0.89-0.95]) was seen, and a moderate-to-good agreement was seen in the assignment of EGJ opening classification, contractile response pattern, and motility classification (κ = 0.68, 0.56, and 0.59, respectively) on FLIP. Rater accuracy for Chicago Classification version 4.0 diagnosis on HRM was 82% (95% confidence interval 78%-84%) and for motility diagnosis on FLIP Panometry was 78% (95% confidence interval 72%-81%).
DISCUSSION
Our study demonstrates high levels of interrater agreement and accuracy in the interpretation of HRM and FLIP metrics and moderate-to-high levels for motility classification in FLIP, supporting the use of these approaches for primary or complementary evaluation of esophageal motility disorders.
Topics: Humans; Reproducibility of Results; Esophageal Motility Disorders; Esophagogastric Junction; Manometry; Peristalsis; Esophageal Achalasia
PubMed: 37042784
DOI: 10.14309/ajg.0000000000002285 -
Neurogastroenterology and Motility Dec 2021Lidocaine is commonly applied to improve the tolerance of esophageal manometry (EM) and ambulatory pH monitoring (PM). We recently published data suggesting a benefit to... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Lidocaine is commonly applied to improve the tolerance of esophageal manometry (EM) and ambulatory pH monitoring (PM). We recently published data suggesting a benefit to this practice and we aimed to confirm these findings in a randomized trial.
METHODS
We conducted a double-blind, randomized trial of lidocaine nasal spray versus placebo (saline) before EM and PM. Patients referred to our center who met inclusion criteria were enrolled. Patients were asked to fill a questionnaire after their test and patient-reported adverse effects were compared.
KEY RESULTS
Three hundred and four patients were enrolled in our trial. Lidocaine and placebo groups were demographically similar. The primary outcome, pain during catheter insertion, occurred in 60/148 (40.5%) patients in the lidocaine group versus in 72/152 (47.4%) patients in the placebo group (OR: 0.76 [95% CI: 0.48-1.20]; p = 0.23). Patients receiving lidocaine were less likely to report nausea during test recording (OR: 0.48 [95% CI: 0.24-0.91]; p = 0.02) and reported slightly lower intensity of pain during both catheter insertion and test recording (4.68 ± 2.06 versus 5.41 ± 2.24 on 10; p = 0.048 and 3.71 ± 2.00 versus 4.93 ± 2.55 on 10; p = 0.03, respectively). Furthermore, patients receiving lidocaine were less likely to report their test as globally uncomfortable and painful (57% vs. 75%; p = 0.003 and 14% vs. 21%; p = 0.02, respectively). No events of systemic lidocaine toxicity occurred during the study period.
CONCLUSIONS
Routine use of lidocaine before esophageal function tests does not reduce pain during catheter insertion but may provide other modest benefits with limited toxicity.
Topics: Administration, Intranasal; Adult; Aged; Anesthetics, Local; Double-Blind Method; Esophageal Motility Disorders; Esophageal pH Monitoring; Female; Humans; Lidocaine; Male; Manometry; Middle Aged; Nausea; Pain; Patient Satisfaction; Treatment Outcome
PubMed: 33969923
DOI: 10.1111/nmo.14167 -
Digestive Diseases and Sciences Mar 2021Elevated colonic pressures and increased colonic activity have been thought to contribute to the pathophysiology of diverticulosis. However, evidence for this has been...
BACKGROUND
Elevated colonic pressures and increased colonic activity have been thought to contribute to the pathophysiology of diverticulosis. However, evidence for this has been limited to low-resolution manometry, which is of limited accuracy.
AIMS
This study aimed to evaluate the contraction pressures, counts, and distance of propagation recorded by high-resolution colonic manometry in diverticulosis vs control patients.
METHODS
High-resolution colonic manometry was used to record descending and sigmoid colon activity pre- and post-meal in patients with established, asymptomatic diverticulosis and in healthy controls. Antegrade and retrograde propagating contractions, distance of propagation (mm), and mean contraction pressures (mmHg) in the descending and sigmoid colon were compared between patients and controls for all isolated propagating contractions, the cyclic motor pattern, and high-amplitude propagating contractions independently.
RESULTS
Mean manometry pressures were not different between controls and diverticulosis patients (p > 0.05 for all comparisons). In the descending colon, diverticulosis patients had lower post-meal mean distance of propagation for all propagating contractions [10.8 (SE1.5) mm vs 20.0 (2.0) mm, p = 0.003] and the cyclic motor pattern [6.0 (2.5) mm vs 17.1 (2.8) mm, p = 0.01]. In the sigmoid colon, diverticulosis patients showed lower post-meal mean distance of propagation for all propagating contractions [10.8 (1.5) mm vs 20.2 (5.9) mm, p = 0.01] and a lower post-meal increase in retrograde propagating contractions (p = 0.04).
CONCLUSIONS
In this first high-resolution colonic manometry study of patients with diverticular disease, we did not find evidence for increased manometric pressures or increased colonic activity in patients with diverticular disease.
Topics: Adult; Aged; Asymptomatic Diseases; Case-Control Studies; Colon, Descending; Colon, Sigmoid; Diverticulum; Female; Gastrointestinal Motility; Humans; Male; Manometry; Meals; Middle Aged; Postprandial Period; Pressure
PubMed: 32399665
DOI: 10.1007/s10620-020-06320-4 -
Medical Engineering & Physics May 2023Non-invasive surface recording devices used for detecting swallowing events include electromyography (EMG), sound, and bioimpedance. However, to our knowledge there are...
OBJECTIVES
Non-invasive surface recording devices used for detecting swallowing events include electromyography (EMG), sound, and bioimpedance. However, to our knowledge there are no comparative studies in which these waveforms were recorded simultaneously. We assessed the accuracy and efficiency of high-resolution manometry (HRM) topography, EMG, sound, and bioimpedance waveforms, for identifying swallowing events.
METHODS
Six participants randomly performed saliva swallow or vocalization of "ah" 62 times. Pharyngeal pressure data were obtained using an HRM catheter. EMG, sound, and bioimpedance data were recorded using surface devices on the neck. Six examiners independently judged whether the four measurement tools indicated a saliva swallow or vocalization. Statistical analyses included the Cochrane's Q test with Bonferroni correction and the Fleiss' kappa coefficient.
RESULTS
Classification accuracy was significantly different between the four measurement methods (P < 0.001). The highest classification accuracy was for HRM topography (>99%), followed by sound and bioimpedance waveforms (98%), then EMG waveform (97%). The Fleiss' kappa value was highest for HRM topography, followed by bioimpedance, sound, and then EMG waveforms. Classification accuracy of the EMG waveform showed the greatest difference between certified otorhinolaryngologists (experienced examiners) and non-physicians (naive examiners).
CONCLUSION
HRM, EMG, sound, and bioimpedance have fairly reliable discrimination capabilities for swallowing and non-swallowing events. User experience with EMG may increase identification and interrater reliability. Non-invasive sound, bioimpedance, and EMG are potential methods for counting swallowing events in screening for dysphagia, although further study is needed.
Topics: Humans; Electromyography; Reproducibility of Results; Deglutition; Manometry; Deglutition Disorders
PubMed: 37120175
DOI: 10.1016/j.medengphy.2023.103980 -
Critical Care (London, England) Jan 2021
Topics: Esophagus; Humans; Manometry; Positive-Pressure Respiration; Respiration, Artificial
PubMed: 33402179
DOI: 10.1186/s13054-020-03453-w -
Langenbeck's Archives of Surgery Dec 2021The evaluation of the upper esophageal sphincter (UES) has been neglected during routine manometric tests for decades, mostly due to the limitations of the conventional... (Review)
Review
BACKGROUND
The evaluation of the upper esophageal sphincter (UES) has been neglected during routine manometric tests for decades, mostly due to the limitations of the conventional manometry which were eventually overcome by high-resolution manometry (HRM).
METHODS
This study reviewed the current knowledge of the manometric evaluation of the UES in health and disease in the HRM era.
RESULTS
We found that HRM allowed more precise measurements, in addition to the parameters as compared to conventional manometry, but most of them still need confirmation of the clinical significance. The parameters used to evaluate the UES were extension, basal pressure, residual pressure, relaxation duration, relaxation time to nadir, recovery time, intrabolus pressure, and deglutitive sphincter resistance. UES may be affected by different diseases: achalasia (UES is hypertonic with impaired relaxation), gastroesophageal reflux disease (UES is short and hypotonic), globus (UES ranges from normal to impaired relaxation to hypertonic), neurologic diseases (stroke and Parkinson - UES is hypotonic in early-stage to impaired relaxation in end-stage disease), and Zenker's diverticulum (UES has impaired relaxation).
CONCLUSION
This review shows that UES dysfunction is part of several disease processes and that the study of the UES is possible and valuable with the aid of HRM.
Topics: Esophageal Achalasia; Esophageal Sphincter, Upper; Gastroesophageal Reflux; Humans; Manometry; Stroke
PubMed: 34462811
DOI: 10.1007/s00423-021-02319-1 -
PloS One 2020There is a need for a lower cost manometry system for assessing anorectal function in primary and secondary care settings. We developed an index finger-based system... (Comparative Study)
Comparative Study Observational Study
There is a need for a lower cost manometry system for assessing anorectal function in primary and secondary care settings. We developed an index finger-based system (termed "digital manometry") and tested it in healthy volunteers, patients with chronic constipation, and fecal incontinence. Anorectal pressures were measured in 16 participants with the digital manometry system and a 23-channel high-resolution anorectal manometry system. The results were compared using a Bland-Altman analysis at rest as well as during maximum squeeze and simulated defecation maneuvers. Myoelectric activity of the puborectalis muscle was also quantified simultaneously using the digital manometry system. The limits of agreement between the two methods were -7.1 ± 25.7 mmHg for anal sphincter resting pressure, 0.4 ± 23.0 mmHg for the anal sphincter pressure change during simulated defecation, -37.6 ± 50.9 mmHg for rectal pressure changes during simulated defecation, and -20.6 ± 172.6 mmHg for anal sphincter pressure during the maximum squeeze maneuver. The change in the puborectalis myoelectric activity was proportional to the anal sphincter pressure increment during a maximum squeeze maneuver (slope = 0.6, R2 = 0.4). Digital manometry provided a similar evaluation of anorectal pressures and puborectalis myoelectric activity at an order of magnitude less cost than high-resolution manometry, and with a similar level of patient comfort. Digital Manometry provides a simple, inexpensive, point of service means of assessing anorectal function in patients with chronic constipation and fecal incontinence.
Topics: Adult; Aged; Aged, 80 and over; Anal Canal; Constipation; Cross-Sectional Studies; Electromyography; Fecal Incontinence; Female; Healthy Volunteers; Humans; Male; Manometry; Middle Aged; Pelvic Floor; Pressure; Rectum; Wearable Electronic Devices
PubMed: 32991595
DOI: 10.1371/journal.pone.0228761 -
Neurogastroenterology and Motility Nov 2022The functional lumen imaging probe (Endoflip™) is increasingly used for evaluation of patients with esophageal symptoms. To improve the interpretation of Endoflip™... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The functional lumen imaging probe (Endoflip™) is increasingly used for evaluation of patients with esophageal symptoms. To improve the interpretation of Endoflip™ in clinical practice, normative values with appropriate cut-off values are required.
METHODS
Original clinical studies describing Endoflip™ use for measurements of esophageal motility in healthy adults were considered. Meta-analysis was performed based on published values.
RESULTS
A total of 17 articles were included in the systematic review, 15 of which were included in the meta-analysis, representing 154 unique subjects. At 40 ml distention, the 5th-95th and 10th-90th percentiles for esophagogastric junction distensibility index (EGJ-DI) were 1.96-10.95 mm /mmHg and 2.36-8.95 mm /mmHg, respectively. An EGJ-DI below 2 mm /mmHg was found in 5.4%, and below 3 mm /mmHg in 20.1% of healthy subjects. At 50 ml distention, the 5th-95th and 10th-90th percentiles for EGJ-DI are 2.86-10.66 mm /mmHg and 3.28-9.12 mm /mmHg, respectively (below 2 mm /mmHg: 0.6%, 3 mm /mmHg: 6.3%). The 5th-95th and 10th-90th percentiles for EGJ-DI at 60 ml distention were 3.06-8.14 mm /mmHg and 3.33-7.18 mm /mmHg, respectively (below 2 mm /mmHg: 0.0%, 3 mm /mmHg: 7%). A clear cut-off for lower values was identified while a large spread in values was observed for upper limits of normal for EGJ-DI for all filling volumes.
CONCLUSIONS
Given these observations, we recommend using a cut-off of 2 mm /mmHg for clinical practice, values below can be considered abnormal. Given that 5.4% of the healthy subjects will have an EGJ-DI below 2 mm /mmHg at 40 ml, we recommend using the 50 and 60 ml distention volumes. The clinical use of an upper limit for normality of EGJ-DI seems questionable.
Topics: Adult; Diagnostic Imaging; Esophageal Achalasia; Esophagogastric Junction; Healthy Volunteers; Humans; Manometry
PubMed: 35665566
DOI: 10.1111/nmo.14419