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Remifentanil alters sensory neuromodulation of swallowing in healthy volunteers: Quantification by a novel pressure-impedance analysis
Speech Pathology and Audiology, School of Health Sciences, Flinders University, Adelaide, Australia.
Human Physiology, Medical Science and Technology, School of Medicine, Flinders University, Adelaide, Australia.
Örebro University, School of Medical Sciences. Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
2016 (English)In: American Journal of Physiology - Gastrointestinal and Liver Physiology, ISSN 0193-1857, E-ISSN 1522-1547, Vol. 310, no 11, p. G1176-G1182Article in journal (Refereed) Published
Abstract [en]

Exposure to remifentanil contributes to an increased risk of pulmonary aspiration, likely through reduced pharyngeal contractile vigour and diminished bolus propulsion during swallowing. Here, we employed a novel high resolution pressure-flow analysis to quantify the biomechanical changes across the upper esophageal sphincter (UES). Eleven healthy young participants (mean age 23.3±3.1 years, 7 male) 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 pharyngo-esophageal manometry and electrical impedance data were recorded using a 4.2 mm diameter catheter housing 36 circumferential pressure sensors. Remifentanil significantly shortened the time period of UES opening (p<0.001) and increased residual UES pressure (p=0.003). At the level of the hypopharynx, remifentanil significantly shortened the time 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 are mechanically consistent with increased flow resistance due to a more rapid bolus flow rate. These biomechanical changes are congruent with modification of the physiologic neuro-regulatory mechanism governing accommodation to bolus volume.

Place, publisher, year, edition, pages
Bethesda, USA: American Physiological Society , 2016. Vol. 310, no 11, p. G1176-G1182
Keywords [en]
Remifentanil, swallowing, high resolution manometry, upper esophageal, sphincter, μ−opioid receptor
National Category
Physiology Gastroenterology and Hepatology
Research subject
Physiology
Identifiers
URN: urn:nbn:se:oru:diva-50320DOI: 10.1152/ajpgi.00138.2016ISI: 000377433200030PubMedID: 27151943OAI: oai:DiVA.org:oru-50320DiVA, id: diva2:931412
Note

Funding Agencies:

Research Fund of the Örebro County Council, Sweden OLL-367441

National Health and Medical Research Council Senior Research Fellowship APP1079715

Available from: 2016-05-27 Created: 2016-05-16 Last updated: 2018-07-10Bibliographically approved

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Savilampi, Johanna

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