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Anorectal manometry with and without ketamine for evaluation of defecation disorders in children.
J Pediatr Surg. 2015 Mar; 50(3):438-43.JP

Abstract

INTRODUCTION

Anorectal manometry (ARCM) provides valuable information in children with chronic constipation and fecal incontinence but may not be tolerated in the awake child. This study aimed to evaluate the effect of ketamine anesthesia on the assessment of anorectal function by manometry and to evaluate defecation dynamics and anal sphincter resting pressure in the context of pathophysiology of chronic functional (idiopathic) constipation and soiling in children.

METHODS

This was a prospective study of children who were investigated for symptoms of chronic constipation and soiling between April 2001 and April 2004. We studied 52 consecutive children who had awake ARCM, biofeedback training and endosonography (awake group) and 64 children who had ketamine anesthesia for ARCM and endosonography (ketamine group). We age matched 31 children who had awake anorectal studies with 27 who had ketamine anesthesia.

RESULTS

The children in awake and ketamine groups were comparable for age, duration of bowel symptoms and duration of laxative treatments. ARCM profile was comparable between the awake and the ketamine groups with regard to anal sphincter resting pressure, rectal capacity, amplitude of rectal contractions, frequency of rectal and IAS contractions and functional length of anal canal. Of 52 children who had awake ARCM, dyssynergia of the EAS muscles was observed in 22 (42%) and median squeeze pressure was 87mm Hg (range 25-134). The anal sphincter resting pressure was non-obstructive and comparable to healthy normal children. Rectoanal inhibitory reflex was seen in all children excluding diagnosis of Hirschsprung disease.

CONCLUSIONS

Ketamine anesthesia does not affect quantitative or qualitative measurements of autonomic anorectal function and can be used reliably in children who will not tolerate the manometry while awake. Paradoxical contraction of the EAS can only be evaluated in the awake children and should be investigated further as the underlying cause of obstructive defecation in patients with chronic functional constipation and soiling.

Authors+Show Affiliations

Evelina London Children's Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, UK. Electronic address: ali.keshtgar@gstt.nhs.uk.Chelsea and Westminster, National Health Service Foundation Trust, London, UK.Evelina London Children's Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, UK.Barts and the London National Health Service Trust, London, UK.Evelina London Children's Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25746704

Citation

Keshtgar, A S., et al. "Anorectal Manometry With and Without Ketamine for Evaluation of Defecation Disorders in Children." Journal of Pediatric Surgery, vol. 50, no. 3, 2015, pp. 438-43.
Keshtgar AS, Choudhry MS, Kufeji D, et al. Anorectal manometry with and without ketamine for evaluation of defecation disorders in children. J Pediatr Surg. 2015;50(3):438-43.
Keshtgar, A. S., Choudhry, M. S., Kufeji, D., Ward, H. C., & Clayden, G. S. (2015). Anorectal manometry with and without ketamine for evaluation of defecation disorders in children. Journal of Pediatric Surgery, 50(3), 438-43. https://doi.org/10.1016/j.jpedsurg.2014.08.016
Keshtgar AS, et al. Anorectal Manometry With and Without Ketamine for Evaluation of Defecation Disorders in Children. J Pediatr Surg. 2015;50(3):438-43. PubMed PMID: 25746704.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anorectal manometry with and without ketamine for evaluation of defecation disorders in children. AU - Keshtgar,A S, AU - Choudhry,M S, AU - Kufeji,D, AU - Ward,H C, AU - Clayden,G S, Y1 - 2014/10/01/ PY - 2013/12/08/received PY - 2014/08/18/revised PY - 2014/08/20/accepted PY - 2015/3/10/entrez PY - 2015/3/10/pubmed PY - 2016/1/1/medline KW - Anorectal KW - Biofeedback KW - Constipation KW - Endosonography KW - Ketamine KW - Manometry SP - 438 EP - 43 JF - Journal of pediatric surgery JO - J. Pediatr. Surg. VL - 50 IS - 3 N2 - INTRODUCTION: Anorectal manometry (ARCM) provides valuable information in children with chronic constipation and fecal incontinence but may not be tolerated in the awake child. This study aimed to evaluate the effect of ketamine anesthesia on the assessment of anorectal function by manometry and to evaluate defecation dynamics and anal sphincter resting pressure in the context of pathophysiology of chronic functional (idiopathic) constipation and soiling in children. METHODS: This was a prospective study of children who were investigated for symptoms of chronic constipation and soiling between April 2001 and April 2004. We studied 52 consecutive children who had awake ARCM, biofeedback training and endosonography (awake group) and 64 children who had ketamine anesthesia for ARCM and endosonography (ketamine group). We age matched 31 children who had awake anorectal studies with 27 who had ketamine anesthesia. RESULTS: The children in awake and ketamine groups were comparable for age, duration of bowel symptoms and duration of laxative treatments. ARCM profile was comparable between the awake and the ketamine groups with regard to anal sphincter resting pressure, rectal capacity, amplitude of rectal contractions, frequency of rectal and IAS contractions and functional length of anal canal. Of 52 children who had awake ARCM, dyssynergia of the EAS muscles was observed in 22 (42%) and median squeeze pressure was 87mm Hg (range 25-134). The anal sphincter resting pressure was non-obstructive and comparable to healthy normal children. Rectoanal inhibitory reflex was seen in all children excluding diagnosis of Hirschsprung disease. CONCLUSIONS: Ketamine anesthesia does not affect quantitative or qualitative measurements of autonomic anorectal function and can be used reliably in children who will not tolerate the manometry while awake. Paradoxical contraction of the EAS can only be evaluated in the awake children and should be investigated further as the underlying cause of obstructive defecation in patients with chronic functional constipation and soiling. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/25746704/Anorectal_manometry_with_and_without_ketamine_for_evaluation_of_defecation_disorders_in_children_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(14)00515-6 DB - PRIME DP - Unbound Medicine ER -