Effects of remifentanil on esophageal motility: a double‐blind, randomized, cross‐over study in healthy volunteers

Savilampi, Johanna; Magnuson, Anders; Ahlstrand, Rebecca

doi:10.1111/aas.12534

Cited by 24 publications

(30 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We report data from 11 healthy young (23.3 Ϯ 3.1 yr old) participants (7 men and 4 women) who were previously enrolled in a double-blind, randomized, placebo-controlled, cross-over study of opioid drugs (27) and had provided informed consent. In this previous publication, we reported pharmacodynamic effects at two time points, 15 and 30 min following commencement of remifentanil infusion.…”

Section: Methodsmentioning

confidence: 99%

“…reported during exposure to remifentanil (27). Specifically, we used mechanical states analysis to deduce the duration of "pause" of neural activation of the CP muscle (23,24).…”

Section: Methodsmentioning

confidence: 99%

“…Based on this premise and in the context of the biomechanical effects of remifentanil on pharyngoesophageal swallowing that we described previously (27)(28)(29), we hypothesized that exposure to remifentanil results in quantifiable changes in pharyngeal bolus propulsion and UES relaxation and opening, producing knock-on effects, such as increased flow resistance across the UES and overall aspiration risk. To test this hypothesis, we conducted an in-depth analysis of the effects of remifentanil on swallowing function.…”

mentioning

confidence: 94%

See 2 more Smart Citations

Remifentanil alters sensory neuromodulation of swallowing in healthy volunteers: quantification by a novel pressure-impedance analysis

Doeltgen

Omari

Savilampi

2016

American Journal of Physiology-Gastrointestinal and Liver Physi

Self Cite

View full text Add to dashboard Cite

Exposure to remifentanil contributes to an increased risk of pulmonary aspiration, likely through reduced pharyngeal contractile vigor and diminished bolus propulsion during swallowing. We employed a novel high-resolution pressure-flow analysis to quantify the biomechanical changes across the upper esophageal sphincter (UES). Eleven healthy young (23.3 ± 3.1 yr old) participants (7 men and 4 women) received remifentanil via intravenous target-controlled infusion with an effect-site concentration of 3 ng/ml. Before and 30 min following commencement of remifentanil administration, participants performed ten 10-ml saline swallows while pharyngoesophageal manometry and electrical impedance data were recorded using a 4.2-mm-diameter catheter housing 36 circumferential pressure sensors. Remifentanil significantly shortened the duration of UES opening (P < 0.001) and increased residual UES pressure (P = 0.003). At the level of the hypopharynx, remifentanil significantly shortened the latency from maximum bolus distension to peak contraction (P = 0.004) and significantly increased intrabolus distension pressure (P = 0.024). Novel mechanical states analysis revealed that the latencies between the different phases of the stereotypical UES relaxation sequence were shortened by remifentanil. Reduced duration of bolus flow during shortened UES opening, in concert with increased hypopharyngeal distension pressures, is mechanically consistent with increased flow resistance due to a more rapid bolus flow rate. These biomechanical changes are congruent with modification of the physiological neuroregulatory mechanism governing accommodation to bolus volume.

show abstract

Section: Methodsmentioning

confidence: 99%

“…reported during exposure to remifentanil (27). Specifically, we used mechanical states analysis to deduce the duration of "pause" of neural activation of the CP muscle (23,24).…”

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 94%

See 1 more Smart Citation

Remifentanil alters sensory neuromodulation of swallowing in healthy volunteers: quantification by a novel pressure-impedance analysis

Doeltgen

Omari

Savilampi

2016

American Journal of Physiology-Gastrointestinal and Liver Physi

Self Cite

View full text Add to dashboard Cite

show abstract

“…Ratuapli et al were also able to demonstrate retrospective in a comparative study an opioid-induced EGJ outflow obstruction and spastic peristalsis in patients with continued opioid therapy compared to patients with at least 24 hours without pain therapy (28). A double-blind, cross-over study in healthy volunteers from Sweden showed that for example remifentanil induces dysfunction of esophageal motility with EGJ relaxation and distance latency decreasing (29). In the present work, the influence was not explicitly investigated.…”

Section: Discussionmentioning

confidence: 57%

Impact of thoracic surgery on esophageal motor function—Evaluation by high resolution manometry

et al. 2017

View full text Add to dashboard Cite

Background: Alteration of esophageal function is a potential risk factor for postoperative complications in thoracic surgery. This prospective study investigates esophageal motility and function during and after thoracic procedures via high resolution manometry (HRM) and impedance technology with spatiotemporal representation of pressure data.Methods: Twelve consecutive patients eligible for elective thoracic surgery underwent preoperative and postoperative (48 hours and 7 days) esophageal HRM. Swallowing acts were carried out with 5 mL of water, 10 mL of water and 1 cm 3 bread in physiological posture to evaluate distal contraction integral (DCI).Length and location of contractile integrity breaks were measured by investigators blinded to the form of surgical intervention. The impact of surgical procedures on esophageal motility was quantified according to current Chicago Classification (CC) criteria. Pre-, intra-and postoperative 24-hour multi-channel impedance pH-metry (MII-pH) was performed to further analyze gastroesophageal reflux patterns.Results: All patients were investigated 48 hours prior to and 7 days after thoracic procedures, with a total of n=675 swallowing acts being included in our study. Increased motility patterns of the tubular esophagus occurred temporally 48 hours postoperatively. DCI 48 hours after surgery increased significantly (5 mL, P=0.049; solid, P=0.014) and returned to baseline values after seven days (5 mL, P=0.039; solid, P=0.039).Break length was significantly reduced 48 hours postoperatively, especially in the proximal esophageal segment (transition zone). Follow-up measurements after another week were comparable to preoperative baseline findings. The perioperative MII-pH measurement showed numerous artifacts caused by intubation and ventilation during surgery also with increasing short and frequent acidic reflux episodes.Conclusions: Thoracic procedures cause a transient modulation of esophageal peristalsis with postoperative increased contractility of the tubular esophagus, presumably without affecting intraesophageal reflex arcs. Although limited by the number of patients, we can conclude on our data that postoperative esophageal hypomotility is unlikely to promote secondary pulmonary complications.

show abstract

“…These studies report aspiration of saliva and nasal secretions in 10-100% of healthy persons, 70% of patients with depressed consciousness, 71% of patients with community-acquired pneumonia, and 100% of patients with chronic sinusitis and asthma. Saliva aspiration has also been found in 48% of patients under sedation with anesthetics [5], and aspiration of gastric contents was found in 8.3% of patients who did not vomit during surgery under general anesthesia [6]. With regard to saliva aspiration when awake, videoendoscopy carried out on 81 patients undergoing otolaryngological examination who did not complain of dysphagia showed saliva aspiration in two cases [7].…”

Section: Introductionmentioning

confidence: 99%

Videoendoscopic Evaluation of Saliva Aspiration in a Municipal Hospital

2015

J Oral Biol

View full text Add to dashboard Cite

Videoendoscopic examination of swallowing is useful to examine for aspiration of saliva and food at the bedside. The purpose of the present study was to compare saliva aspiration to aspiration of food in patients with dysphagia. The subjects were 120 hospitalized patients (73 males, 47 females; mean age 82.8 ± 8.5 yrs) who underwent videoendoscopy. The presence of saliva aspiration, food (thick liquid of two different viscosities, thin liquid and solid food) aspiration, silent aspiration, and aspiration after swallowing were evaluated in each patient. Saliva aspiration was found in 41 (34.2%) patients. Aspiration of liquids with honey-like and nectar-like thicknesses was found in 28 (23.3%) patients and 48 (40.0%) patients, respectively. The total number of cases of aspiration of saliva and/or food was 104 (86.7%). Of these aspirators, silent aspiration was found in 44 (36.7%) patients, and aspiration after swallowing was found in 52 (43.3%) patients. Thick liquid was aspirated more frequently in patients with saliva aspiration. The proportion of silent aspiration and of aspiration after swallowing was higher in the saliva aspiration group. The results indicate that patients who aspirate saliva are also prone to food aspiration. But, there were patients who aspirated saliva but did not aspirate food. These patients were able to carry out direct therapy using thick liquid or other food adjusted properly. Food aspiration after swallowing may be induced by saliva aspiration.the larynx. Thus, saliva accumulates in the hypopharynx and trickles into the trachea during the swallowing reflex and in the intervals between the swallowing reflexes clinically. For patients with saliva aspiration, exercises without food (indirect therapy) are carried out to improve this pharyngeal function first. However, we sometimes encounter patients who can carry out training using food (direct therapy) even if they aspirate saliva. There have been few reports to date regarding the relationship between saliva aspiration and food aspiration. In this study, videoendoscopic examination of swallowing was used to compare saliva aspiration to aspiration of thick liquid with two types of viscosity (nectar-like and honey-like) and other food in patients with dysphagia hospitalized in municipal hospitals. Materials and Methods SubjectsSubjects included 124 patients who were hospitalized at Iida Hospital in Nagano Prefecture between September 2011 and September 2013 who had dysphagia and underwent videoendoscopic examination of swallowing. Four patients who underwent tracheotomy were excluded, giving a final total of 120 patients (73 males, 47 females; mean age 82.8 ± 8.5 yrs, age range 56-98 yrs). The most common reason for hospitalization was pneumonia, accounting for half of the patients, followed by cerebrovascular disease (Table 1). The most common primary disease underlying dysphagia was cerebrovascular disease (Table 2). The nutritional route was oral ingestion alone in 31 patients, combined oral ingestion and tube feeding in 32 pat...

show abstract

Effects of remifentanil on esophageal motility: a double‐blind, randomized, cross‐over study in healthy volunteers

Abstract: Remifentanil induces dysfunction of esophageal motility; this may contribute to the elevated risk of regurgitation and aspiration.

Cited by 24 publications

References 30 publications

Remifentanil alters sensory neuromodulation of swallowing in healthy volunteers: quantification by a novel pressure-impedance analysis

Remifentanil alters sensory neuromodulation of swallowing in healthy volunteers: quantification by a novel pressure-impedance analysis

Impact of thoracic surgery on esophageal motor function—Evaluation by high resolution manometry

Videoendoscopic Evaluation of Saliva Aspiration in a Municipal Hospital

Contact Info

Product

Resources

About