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July 1975, Vol 110, No. 7 >
ARTICLE | July 1975

Spasm and Operative Cholangiography

JACOBUS W. MOSTERT, MD
Arch Surg. 1975;110(7):847. doi:10.1001/archsurg.1975.01360130079022.
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To the Editor.—Drs. Chessick et al (Arch Surg 110:53, 1975) should be congratulated for their valuable observation that fentanyl produces "severe spasm of the sphincter of Oddi that is variable and not dose related." However, I found no evidence to support the claim that the response is variable, and I think the editorial by Francis Scholz, MD, that accompanied the article (Arch Surg 110:17, 1975) might well give the wrong impression. It is a fact of life at the present time that fentanyl remains the anesthetic drug of choice for surgery on the biliary tract. Tremblay et al1 measured the pressure in the common bile duct at the level of the sphincter of Oddi in nine patients before and after intravenous injection of 0.05 mg fentanyl. Elevation of pressure was observed three to five minutes later, but the peak declined rapidly, so that 25 minutes after the injection

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