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Effects of remifentanil on esophageal motility: A double blind, randomized, cross-over study in healthy volunteers
Örebro University Hospital. Department of Anesthesiology and Intensive Care.
Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
Örebro University Hospital. Department of Anesthesiology and Intensive Care.
2015 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, no 9, 1126-1136 p.Article in journal (Refereed) Published
Abstract [en]

Background: Recent studies have shown that remifentanil increases the risk of aspiration and induces subjective swallowing difficulties. The mechanisms are not completely understood. Here, we investigated whether remifentanil impairs esophageal motility and hypothesized that this is one possible underlying mechanism. Naloxone was used to evaluate whether the effects of remifentanil are mediated through opioid receptors. We also examined subjective swallowing difficulties and the influence of metoclopramide on remifentanil-induced effects.

Methods: Fourteen healthy volunteers participated in a double-blind, randomized, 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 naloxone given as a bolus of 6g/kg followed by an infusion of 0.1g/kg/min, or saline 5min before target-controlled infusions of remifentanil at three target-site concentrations: 1, 2, and 3 ng/ml. On both occasions, 0.2mg/kg metoclopramide was given before the final measurement. Five swallows were performed during each measuring condition, and the metrics defining esophageal motility were measured by high-resolution manometry. Outcomes were differences in the metrics at baseline vs. during remifentanil infusion, with naloxone vs. placebo, and with remifentanil before and after metoclopramide administration. Differences in swallowing difficulties were also recorded.

Results: Remifentanil decreased swallow-evoked esophagogastric junction relaxation and the latency time of esophageal peristalsis. There were no significant effects of naloxone or metoclopramide on remifentanil-induced effects, and we detected no differences in swallowing difficulties.

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

Place, publisher, year, edition, pages
2015. Vol. 59, no 9, 1126-1136 p.
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
URN: urn:nbn:se:oru:diva-44661DOI: 10.1111/aas.12534ISI: 000360982900006PubMedID: 25923045Scopus ID: 2-s2.0-84941254659OAI: oai:DiVA.org:oru-44661DiVA: diva2:812768
Note

Funding Agency:

Örebro County Council

Available from: 2015-05-20 Created: 2015-05-20 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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Citation style
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