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Aspiration Induced by Remifentanil: A Double-blind, Randomized, Crossover Study in Healthy Volunteers
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Anaesthesiology and Intensive Care.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Anaesthesiology and Intensive Care; Centre for Health Care Sciences.
Clinical Epidemiology and Biostatistic Unit, Örebro University Hospital, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Radiology.ORCID iD: 0000-0003-3253-8967
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2014 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 121, no 1, 52-58 p.Article in journal (Refereed) Published
Abstract [en]

Background: Remifentanil is widely used for monitored anesthesia care in spontaneously breathing patients. However, the authors' previous studies have shown that remifentanil induces subjective swallowing difficulties, which may increase the risk of aspiration.

Methods: Twenty-five healthy volunteers participated in a double-blind, randomized, crossover trial at the University Hospital in orebro, orebro, Sweden. The volunteers were studied on two different occasions during which they received either remifentanil with an effect-site target concentration of 3 ng/ml or saline over 1 h. A radionuclide tracer was infused simultaneously into the nasopharynx at a rate of 0.1 ml/min. Aspiration was determined by lung scans, and subjective swallowing difficulties and grip strength were evaluated. The primary outcome was the difference in occurrence of aspiration between remifentanil and placebo treatments. The secondary outcomes were differences in swallowing difficulty and grip strength and the association between aspiration and swallowing difficulty.

Results: During remifentanil and placebo infusion, 48 and 12% of the volunteers aspirated, respectively, difference: 36% (95% CI, 10 to 62%). A similar significant difference was found for swallowing difficulties but not for the association between aspiration and swallowing. No difference was found in grip strength between the two treatments.

Conclusions: Remifentanil infusion at concentrations used in monitored anesthesia care increases the incidence of aspiration. However, the subjective swallowing difficulty induced by remifentanil is not indicative of the aspiration risk.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2014. Vol. 121, no 1, 52-58 p.
National Category
Anesthesiology and Intensive Care
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-35818DOI: 10.1097/ALN.0000000000000202ISI: 000337758500010PubMedID: 24598216Scopus ID: 2-s2.0-84902874808OAI: oai:DiVA.org:oru-35818DiVA: diva2:741263
Note

Funding Agency:

Research Fund of the Örebro County Council, Örebro, Sweden

Available from: 2014-08-27 Created: 2014-07-30 Last updated: 2017-10-18Bibliographically approved
In thesis
1. Effects of remifentanil on esophageal sphincters and swallowing function
Open this publication in new window or tab >>Effects of remifentanil on esophageal sphincters and swallowing function
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Örebro: Örebro university, 2015. 57 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 119
Keyword
Pulmonary aspiration, postoperative lung complications, silent aspiration, defence against pulmonary aspiration, remifentanil, competence, of esophageal sphincters, esophageal peristalsis, pharyngeal swallowing, high resolution manometry
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
urn:nbn:se:oru:diva-42216 (URN)978-91-7529-065-2 (ISBN)
Public defence
2015-04-17, Universitetssjukhuset, Wilandersalen, Södra Grev Rosengatan, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2015-01-26 Created: 2015-01-26 Last updated: 2017-10-17Bibliographically approved

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Savilampi, JohannaAhlstrand, RebeccaGeijer, HåkanWattwil, Magnus
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