The following is a summary of “Accuracy of Anorectal Manometry to Detect the Rectoanal Inhibitory Reflex in Children: Awake Versus Under General Anesthesia,” published in the June 2023 issue of Pediatrics by Baaleman, et al.

For a study, researchers sought to compare the detection of the rectoanal inhibitory reflex (RAIR) between awake anorectal manometry (ARM) and ARM performed under general anesthesia.

A retrospective analysis was conducted on ARM studies to identify pediatric patients who underwent both awake and general anesthesia ARM procedures. The outcomes measured included the identification of the RAIR and the resting pressure of the anal canal.

A total of 34 children (53% female) met the inclusion criteria, with a median age of 7.5 years (range: 3-18 years) at their first ARM. Among the participants, the RAIR was detected exclusively during ARM under general anesthesia but not during awake ARM in 9 out of 34 cases (26%). In 6 of these cases (66%), the absence of RAIR during awake ARM was unrelated to the balloon volumes used during the procedure. In 4 out of 34 cases (12%), the assessment of the RAIR during ARM under general anesthesia was inconclusive due to low anal canal pressure or complete loss of pressure. However, in 2 of these cases, RAIR was observed during awake ARM. The anal canal resting pressures were significantly higher during awake ARM compared to ARM under general anesthesia (median: 70 mmHg [interquartile range, IQR: 59-85] vs. 46 mmHg [IQR: 36-65], respectively; P < 0.001).

The use of general anesthesia may impact the detection of RAIR in two distinct ways. It may facilitate the visualization of RAIR in cases where it was not observed during awake ARM. Conversely, general anesthesia can lead to a loss of anal canal pressure, resulting in inconclusive test results.

Source: journals.lww.com/jpgn/Fulltext/2023/06000/Accuracy_of_Anorectal_Manometry_to_Detect_the.8.aspx