ABSTRACT
The effect of intravenous fentanyl [1 microgram/kg] on common bile duct pressure [CBDP] was studied in 30 patients, with cholelithiasis, undergoing open cholecystectomy. Intraoperative water manometry of CBDP revealed a significant rise from 14 +/- 4.3 cm H20 to 15.5 +/- 4.4 cm H20 after fentanyl [P = 0.02]. Such rise was only significant in patients above the age of 35 years [P = 0.04]. However peroperative cholangiography confirmed that this rise in CBDP was not associated with hindrance of the flow of dye into the duodenum. It is concluded that intravenous fentanyl [in the specified dosage] was associated with a significant rise in CBDP especially among patients in the older age group [> 35 years]. It did not, however, cause clinically significant sphincteric spasm to prevent flow of dye into the duodenum and hence is safe to use in biliary surgery
Subject(s)
Common Bile Duct/drug effectsABSTRACT
Many reports have studied the effect of narcotics on the terminal bile ducts and oddi's Sphincter, which demonstrate that narcotics mainly morphine produce slow and prolonged increase in common bile duct pressure. The aim of our study was to compare between the effects on the common bite duct: pressure of either intravenous bolus or intermittent injection of equianalgesic doses of commonly used narcotics mainly Fentanyl, Meperidine and Nalbuphine during cholecystectomy operations. Sixty patients scheduled for elective cholecystectomy were participated to the study the effect of equianalgesic doses of Fentanyl, Mepredin and Nubain either in the form of bolus or intermittent way. Premedication with 10 mg valium only. After anaesthesia and exploration, the cystic duct cannulated and measurement of the interacholiedochal pressure by modified caroli apparatus. Comparing the predrug value and postdrug. value indicate that there is significant increase in the common bile duct pressure in both Fentanyl and Meperidine when the drugs given in bolus way, while if given through intermittent method only the meperidin raise the pressure while the fentanyl did not increase the Pressure. Nubain did not cause any increase in the common bile duct pressure either if it is given on bolus or intermittent method
Subject(s)
Humans , Common Bile Duct/drug effects , Cystic Duct , General Surgery/methods , Cholecystectomy/methodsABSTRACT
Descreve-se um estudo experimental para verificar o comportamento das pressöes da via biliar de cäes após a administraçäo de drogas venosas. Foram estudados 45 cäes divididos em três grupos de 15 e identificados de acordo com a droga empregada por via venosa: nalbufina, fentanil e quetamina. A induçäo da anestesia em todos os grupos foi realizada com tiopental sódico por via venosa e o relaxamento muscular foi obtido com galamina. A ventilaçäo foi controlada manual, através de um AMBU, utilizando ar atmosférico. No grupo da nalbufina foi administrada dose única de 1 mg.kg-1. No grupo do fentanil, uma dose inicial de 10 micron g.kg-1 era injetada no tempo 0(zero); metade desta era repetida 15 minutos após. No grupo da quetamina era injetada uma dose inicial de 2 mg.kg-1 e repetida 15 minutos após. As pressöes da via biliar foram medidas através de um catéter colocado na vesícula dos animais. Após a administraçäo do fentanil houve um aumento significante (p < 0,05) na pressäo colecistociânica. Os valores médios se elevaram de 7,6 + ou - 3,9 cm H2O (basal) para 12,3 + ou - 7,1 cm H2O aos 25 minutos (pico). Quando a nalbufina foi usada a pressäo colecistociânica aumentou muito pouco; do valor basal médio de 7,6 + ou - 3,9 cm H2O elevou-se a um máximo de 9,1 + ou - 5,7 cm H2O aos 30 minutos. A quetamina praticamente näo elevou a pressäo colecistociânica. As variaçöes da pressäo arterial, embora tenham sido significantes com os três agentes, näo chegaram a níveis que pudessem produzir repercussäo clínica. Conclui-se que os morfinomimétricos em estudo determinam aumento da pressäo colecistociânica do cäo; tal alteraçäo é pronunciada com o uso de fentanil embora seja ignorado qual o comportamento da árvore biliar caso o estudo tivesse sido mais prolongado no grupo da nalbufina. A quetamina näo altera a pressäo da via biliar