Effects on the lower oesophageal sphincter of cisapride given before the combined administration of atropine and neostigmine

Abstract

Twenty healthy female patients undergoing laparoscopy were allocated randomly to receive either cisapride 10 mg i.v. in 5% dextrose 20 ml or placebo 15 min before antagonism of residual neuromuscular blockade with atropine 1.2 mg and neostigmine 2.5 mg. Barrier pressure (BrP = lower oesophageal sphincter (LOS) pressure minus gastric pressure) increased significantly (by 25%) following cisapride, but not placebo, within 10 min of injection; following the combined administration of atropine and neostigmine, there was an abrupt decrease in mean BrP in the cisapride group from 37.0 (SEM 4.5) cm H2O to 24.1 (3.2) cm H2O (P less than 0.01) and in the control group from 26.6 (4.8) cm H2O to 19.9 (3.1) cm H2O (P less than 0.05) 2 min after injection. Subsequently, there was a small increase in BrP to values not significantly lower than control measurements. Thus the administration of cisapride before antagonism of neuromuscular blockade with atropine and neostigmine failed to block the adverse effect of atropine on the LOS.