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Effects of remifentanil on esophageal and esophagogastric junction (EGJ) bolus transit in healthy volunteers using novel pressure-flow analysis
Gastroenterology & Hepatology, Flinders Medical Centre, Bedford Park SA, Australia; School of Medicine, Flinders University of South Australia, Adelaide, Australia.
Speech Pathology, School of Health Sciences, Flinders University of South Australia, Adelaide, Australia.
School of Medicine, Flinders University of South Australia, Adelaide, Australia; Human Physiology, Medical Science and Technology, Flinders University of South Australia, Adelaide, Australia.
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Anaesthesiology and Intensive Care.
2018 (English)In: Neurogastroenterology and Motility, ISSN 1350-1925, E-ISSN 1365-2982, Vol. 30, no 2, article id e13191Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Remifentanil is associated with subjective dysphagia and an objective increase in aspiration risk. Studies of opioid effects have shown decreased lower esophageal sphincter relaxation. We assessed bolus transit through the esophagus and esophagogastric junction (EGJ) during remifentanil administration using objective pressure-flow analysis.

METHODS: Data from 11 healthy young participants (23±3 years, 7 M) were assessed for bolus flow through the esophagus and EGJ using high-resolution impedance manometry (Manoscan™, Sierra Scientific Instruments, Inc., LES Angeles, CA, USA) with 36 pressure and 18 impedance segments. Data were analyzed for esophageal pressure topography and pressure-flow analysis using custom Matlab analyses (Mathworks, Natick, USA). Paired t tests were performed with a P-value of < .05 regarded as significant.

KEY RESULTS: Duration of bolus flow through (remifentanil/R 3.0±0.3 vs baseline/B 5.0 ± 0.4 seconds; P < .001) and presence at the EGJ (R 5.1 ± 0.5 vs B 7.1 ± 0.5 seconds; P = .001) both decreased during remifentanil administration. Distal latency (R 5.2 ± 0.4 vs B 7.5 ± 0.2 seconds; P < .001) and distal esophageal distension-contraction latency (R 3.5 ± 0.1 vs B 4.7 ± 0.2 seconds; P < .001) were both reduced. Intrabolus pressures were increased in both the proximal (R 5.3 ± 0.9 vs B 2.6 ± 1.3 mm Hg; P = .01) and distal esophagus (R 8.6 ± 1.7 vs B 3.1 ± 0.8 mm Hg; P = .001). There was no evidence of increased esophageal bolus residue.

CONCLUSIONS AND INFERENCES: Remifentanil-induced effects were different for proximal and distal esophagus, with a reduced time for trans-sphincteric bolus flow at the EGJ, suggestive of central and peripheral μ-opioid agonism. There were no functional consequences in healthy subjects.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018. Vol. 30, no 2, article id e13191
Keywords [en]
Dysphagia, esophagus, motility, opioids
National Category
Medical Laboratory and Measurements Technologies Gastroenterology and Hepatology Neurology
Identifiers
URN: urn:nbn:se:oru:diva-61712DOI: 10.1111/nmo.13191ISI: 000427292000017PubMedID: 28833926Scopus ID: 2-s2.0-85040788155OAI: oai:DiVA.org:oru-61712DiVA, id: diva2:1156416
Note

Funding Agencies:

Australian National Health and Medical Research Council Senior Research Fellowship  APP1079715 

Research Fund of the Orebro County Council, Sweden 

Available from: 2017-11-13 Created: 2017-11-13 Last updated: 2018-04-09Bibliographically approved

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