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Effects of remifentanil on the esophagogastric junction and swallowing
Örebro University Hospital. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
Örebro University Hospital. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden .
Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden .
2013 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 57, no 8, p. 1002-1009Article in journal (Refereed) Published
Abstract [en]

Background: A recent study demonstrated that reflux is associated with impaired pressure augmentation in the esophagogastric junction (EGJ), caused by diaphragmal contractions during inspiration. It is unknown whether this augmentation is influenced by opioids. Swallowing difficulties can be a poorly recognised side effect of remifentanil. Here, we investigated whether remifentanil influences inspiratory EGJ augmentation and evaluated subjective swallowing difficulties induced by remifentanil. We also used the peripheral opioid receptor antagonist methylnaltrexone to evaluate whether these effects are centrally or peripherally mediated.

Methods: Ten healthy volunteers participated in a double-blind, randomised, cross-over trial at the University Hospital in orebro, Sweden. They were studied on two different occasions, during which they were randomly assigned to receive either methylnaltrexone 0.15mg/kg or saline subcutaneously 30min before the target-controlled infusion of remifentanil of 3ng/mL. EGJ pressures were measured by high-resolution manometry. Swallowing difficulties were assessed when volunteers performed dry swallows. The outcomes were the differences in EGJ pressures at baseline and during remifentanil infusion and with methylnaltrexone vs. placebo. Differences in swallowing difficulties before and during remifentanil, and with methylnaltrexone vs. placebo were also recorded.

Results: Remifentanil decreased the inspiratory EGJ augmentation and induced swallowing difficulties. No statistically significant differences between methylnaltrexone and placebo occasions were found.

Conclusions: Remifentanil may increase risk for gastroesophageal reflux by decreasing the inspiratory EGJ augmentation. The clinical significance of remifentanil-induced swallowing difficulties is to be studied further. Given the limited sample size, it cannot be concluded whether these effects are centrally or peripherally mediated.

Place, publisher, year, edition, pages
2013. Vol. 57, no 8, p. 1002-1009
Keywords [en]
Adult, Anesthetics, Intravenous, Cross-Over Studies, Data Interpretation, Statistical, Deglutition, Double-Blind Method, Esophagogastric Junction, Female, Humans, Male, Manometry, Naltrexone, Narcotic Antagonists, Piperidines, Quaternary Ammonium Compounds, Receptors, Opioid, mu, Stomach, Young Adult
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
URN: urn:nbn:se:oru:diva-38729DOI: 10.1111/aas.12134ISI: 000323075000008PubMedID: 23713743Scopus ID: 2-s2.0-84881666944OAI: oai:DiVA.org:oru-38729DiVA, id: diva2:764227
Note

Funding agencieas are:

Wyeth AB, Solna, Sweden

Orebro County Council

Available from: 2014-11-18 Created: 2014-11-18 Last updated: 2018-08-27Bibliographically 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. p. 57
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 119
Keywords
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, Rebecca

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