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  • 1.
    Ander, Fredrik
    et al.
    Örebro University, School of Medical Sciences. Department of Anaesthesia and Intensive Care, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Magnuson, Anders
    de Leon, Alex
    Department of Anaesthesia and Intensive Care, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Ahlstrand, Rebecca
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Anaesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Does the β-receptor antagonist esmolol have analgesic effects?: A randomised placebo-controlled cross-over study on healthy volunteers undergoing the cold pressor test2018In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 3, p. 165-172Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Esmolol may attenuate the sympathetic response to pain and reduce postoperative opioid consumption. It is not clear whether esmolol has an analgesic effect per se.

    OBJECTIVES: The aim of this study was to evaluate the analgesic effect of esmolol in the absence of anaesthetics and opioids. We tested the hypothesis that esmolol would reduce the maximum pain intensity perceived during the cold pressor test (CPT) by 2 points on a 0 to 10 numeric pain rating scale (NRS) compared to placebo.

    DESIGN: Randomised, placebo-controlled cross-over study.

    SETTING: Postoperative recovery area, Örebro University Hospital. Study period, November 2013 to February 2014.

    PARTICIPANTS: Fourteen healthy volunteers. Exclusion criteria included ongoing medication, pregnancy and breastfeeding and participation in other medical trials.

    INTERVENTIONS: At separate study sessions, participants received interventions: esmolol (0.7 mg kg bolus over 1 min followed by infusion at 10 μg kg min); 0.9% normal saline bolus then remifentanil infusion at 0.2 μg kg min and 0.9% normal saline bolus and infusion according to a random sequence. All infusions were administered over 30 min.

    MAIN OUTCOME MEASURES: Perceived maximum pain intensity score, pain tolerance and haemodynamic changes during CPT, and occurrence of side-effects to interventions compared to placebo, respectively.

    RESULTS: Esmolol did not reduce perceived pain intensity or pain tolerance during the CPT. The NRS-max score was similar for esmolol, 8.5 (±1.4) and placebo, 8.4 (±1.3). The mean difference was 0.1 [95% confidence interval (-1.2 to 1.4)], P value equal to 0.83. Remifentanil significantly reduced NRS-max scores, 5.4 (±2.1) compared to placebo, [mean difference -3.1 (95% confidence interval (-4.4 to -1.8)), P < 0.001]. Side-effects were seen with remifentanil but not with esmolol.

    CONCLUSION: No direct analgesic effect of esmolol could be demonstrated in the present study. The postoperative opioid-sparing effect demonstrated in previous studies, could therefore be secondary to other factors such as avoidance of opioid-induced hyperalgesia, synergy with coadministered opioids or altered pharmacokinetics of those drugs.

    TRIAL REGISTRATION: European clinical trials database, https://eudract.ema.europa.eu/, EudraCT no. 2011-005780-24.

  • 2.
    Cajander, Per
    et al.
    Örebro University, School of Medical Sciences. epartment of Anaesthesia and Intensive Care, Örebro, Sweden.
    Edmark, Lennart
    Department of Anaesthesia and Intensive Care, Västerås, Sweden.
    Ahlstrand, Rebecca
    Örebro University, School of Medical Sciences. Department of Anaesthesia and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Magnuson, Anders
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    de Leon, Alex
    Department of Anaesthesia and Intensive Care, Sahlgrenska University Hospital, Göteborg, sWeden; School of Medical Sciences, Örebro University, Örebro, Sweden.
    Effect of positive end-expiratory pressure on gastric insufflation during induction of anaesthesia when using pressure-controlled ventilation via a face mask: A randomised controlled trial2019In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 36, no 9, p. 625-632Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Face mask ventilation (FMV) during induction of anaesthesia is associated with risk of gastric insufflation that may lead to gastric regurgitation and pulmonary aspiration. A continuous positive airway pressure (CPAP) has been shown to reduce gastric regurgitation. We therefore hypothesised that CPAP followed by FMV with positive end-expiratory pressure (PEEP) during induction of anaesthesia would reduce the risk of gastric insufflation.

    OBJECTIVE: The primary aim was to compare the incidence of gastric insufflation during FMV with a fixed PEEP level or zero PEEP (ZEEP) after anaesthesia induction. A secondary aim was to investigate the effects of FMV with or without PEEP on upper oesophageal sphincter (UES), oesophageal body and lower oesophageal sphincter (LES) pressures.

    DESIGN: A randomised controlled trial.

    SETTING: Single centre, Department of Anaesthesia and Intensive Care, Örebro University Hospital, Sweden.

    PARTICIPANTS: Thirty healthy volunteers.

    INTERVENTIONS: Pre-oxygenation without or with CPAP 10 cmH2O, followed by pressure-controlled FMV with either ZEEP or PEEP 10 cmH2O after anaesthesia induction.

    MAIN OUTCOME MEASURES: A combined impedance/manometry catheter was used to detect the presence of gas and to measure oesophageal pressures. The primary outcome measure was the cumulative incidence of gastric insufflation, defined as a sudden anterograde increase in impedance of more than 1 kΩ over the LES. Secondary outcome measures were UES, oesophageal body and LES pressures.

    RESULTS: The cumulative incidence of gastric insufflation related to peak inspiratory pressure (PIP), was significantly higher in the PEEP group compared with the ZEEP group (log-rank test P < 0.01). When PIP reached 30 cmH2O, 13 out of 15 in the PEEP group compared with five out of 15 had shown gastric insufflation. There was a significant reduction of oesophageal sphincter pressures within groups comparing pre-oxygenation to after anaesthesia induction, but there were no significant differences in oesophageal sphincter pressures related to the level of PEEP.

    CONCLUSION: Contrary to the primary hypothesis, with increasing PIP the tested PEEP level did not protect against but facilitated gastric insufflation during FMV. This result suggests that PEEP should be used with caution after anaesthesia induction during FMV, whereas CPAP during pre-oxygenation seems to be safe.

    TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02238691.

  • 3.
    de Leon, Alex
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ahlstrand, Rebecca
    Örebro University, School of Health and Medical Sciences.
    Thörn, Sven-Egron
    Örebro University, School of Health and Medical Sciences.
    Wattwil, Magnus
    Effects of propofol on oesophageal sphincters: a study on young and elderly volunteers using high-resolution solid-state manometry2011In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 28, no 4, p. 273-278Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE:

    The oesophageal sphincters play an important role in protecting the airway. During manometric studies, administration of an anxiolytic agent is often required to make insertion of the catheter acceptable for the patient. The anxiolytic should not affect the results of the measurements. This study evaluates the effects of two different doses of propofol on the pressures in the oesophageal sphincters. The effect of increased abdominal pressure was also studied.

    METHODS:

    Twenty healthy volunteers, 10 young (mean age 25 years) and 10 elderly (mean age 71 years), were recruited. The effects of a low dose of propofol [0.3 mg kg(-1) intravenously (i.v.)] and a high dose of propofol (young group 0.9 mg kg(-1) i.v. and elderly group 0.6 mg kg(-1) i.v.) were studied with and without external abdominal pressure.

    RESULTS:

    There were no statistically significant changes in lower oesophageal sphincter (LOS) pressure after the low dose of propofol. After the high dose, there was an increase in LOS pressure, which was statistically significant in the young group (P < 0.05). The upper oesophageal sphincter (UOS) pressure decreased after both doses of propofol (P < 0.01 for the higher dose and P < 0.05 for the lower dose).

    CONCLUSION:

    A low dose of propofol (0.3 mg kg(-1) i.v.) leaves the LOS unaffected in young and elderly volunteers and can be used safely as an anxiolytic agent during studies of the LOS without influencing the results. However, the UOS is more sensitive to the effects of propofol and we do not recommend the use of propofol as an anxiolytic agent during manometric studies of the UOS.

  • 4.
    Fant, Federica
    et al.
    Dept. anasthesiology and intensive care, Örebro University Hospital, Örebro, Sweden; Dept. anasthesiology and intensive care, Danderyds Hospital, Danderyd, Sweden.
    Tina, Elisabet
    Örebro University, School of Medical Sciences.
    Andersson, Sven Olof
    Dept. urology and The Health Academy, Örebro University Hospital, Örebro, Sweden.
    Magnuson, Anders
    Clinical epidemiology and biostatics, Faculty of medicine and health, Örebro University Hospital, Örebro, Sweden.
    Hultgren-Hörnquist, Elisabeth
    Örebro University, School of Medical Sciences.
    Gupta, Anil
    Dept. Anasthesiology and intensive care, Örebro University Hospital, Örebro, Sweden; Dept. of anasthesiology, surgical services and intensive care medicine, Karolinska University Hospital, Stockholm, Sweden.
    Early perioperative immunological effects of anaesthesia and analgesia in patients undergoing prostate cancer surgery: A randomised pilot study.2017In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 34, no 4, p. 241-243Article in journal (Refereed)
  • 5.
    Jildenstål,, Pether K.
    et al.
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Hallén, Jan L.
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Rawal, Narinder
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden; Department of Anaesthesiology, Linköping University, Linköping, Sweden.
    Berggren, Lars
    Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden: Centre for Assessment of Medical Technology, Örebro University Hospital, Örebro, Sweden.
    Effect of auditory evoked potential-guided anaesthesia on consumption of anaesthetics and early postoperative cognitive dysfunction: a randomised controlled trial2011In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 28, no 3, p. 213-219Article in journal (Refereed)
    Abstract [en]

    Background: Post-operative cognitive dysfunction (POCD) after non-cardiac surgery is a well known problem in some categories of patients. This study aims to evaluate the influence of auditory evoked potential (AEP)-guided anaesthesia on the requirement for anaesthetic drugs and their influence on POCD.

    Methods: Four hundred and fifty patients aged between 18 and 92 years scheduled for ophthalmic surgery under general anaesthesia were assigned randomly to one of two groups. In group A (AEP group), the depth of anaesthesia (DoA) was aimed at an AEP index (AAI) between 15 and 25. In group C (control group), DoA was guided by clinical signs. Hypotension was treated with fluids and vasopressors using a standardised algorithm. A mini-mental test and the Cognitive Failure Questionnaire were used to evaluate cognitive function.

    Results: Anaesthetic drug requirements were significantly lower in group A than in group C: propofol 92.526.5 vs. 103.839.5mg (P¼<0.001) and desflurane end-tidal concentration 2.50.58 vs. 3.30.79% (P<0.001). In group A, 36 patients (16%) received additional fluids and vasopressors compared to 65 patients (29%) in group C (P<0.01). AAI values differed significantly between the groups: 18 (11–21) in group A vs. 12 (10–19) in group C (P<0.001). The number of patients with POCD was 16 in group C compared to two in group A (P<0.001) at day 1 post-operation.

    Conclusion: AEP monitoring allows dose reduction of anaesthetic agents, leading to better cardiovascular stability and decreased requirements for intra-operative fluids and vasopressors. Cognitive decline seen following minor ophthalmic surgery, even when anaesthesia is assessed clinically, is short-lived with no long-term sequelae.

  • 6.
    Nilsson, Ulrica
    et al.
    Department of Anaesthesia and Intensive Care and Centre for Healthcare Sciences, Orebro University Hospital, Orebro, Sweden.
    Berg, Katarina
    Department of Medical and Health Sciences,, Sweden.
    Unosson, Mitra
    Department of Medical and Health Sciences,, Sweden; Department of Social and Welfare Studies, Linkoping University, Linkoping, Sweden.
    Brudin, Lars
    Kalmar County Council, Kalmar, Sweden.
    Idvall, Ewa
    Department of Medical and Health Sciences,, Sweden; Kalmar County Council, Kalmar, Sweden.
    Relation between personality and quality of postoperative recovery in day surgery patients2009In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 26, no 8, p. 671-675Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE: Personality factors have been found to influence long-term postoperative depressive symptoms, health and distress in inpatients. To our knowledge, no studies have analysed whether the personality traits of day surgery patients relate to postoperative recovery. Hence, this study aims to explore possible relationships between personality traits and the quality of postoperative recovery in patients undergoing day surgery.

    METHODS: Our study used a consecutive sample of 260 day surgery patients to explore possible relationships between personal traits, measured by a short Big Five scale, and postoperative recovery, measured by modified Quality of Recovery-40, on postoperative days 1, 7 and 14.

    RESULTS: We found a positive correlation in changes of 'physical independence' and 'extroversion' (r = 0.20; P = 0.010) and 'intellect' (r = 0.18; P = 0.021) on postoperative days 1 and 7. These correlations were not observed on postoperative day 14. With regard to the change between days 7 and 14, correlations were found between 'physical interdependence' and 'agreeableness' and between 'physical interdependence' and 'conscientiousness' (r = -0.17; P = 0.028-0.030 for both).

    CONCLUSION: Day surgery patients appear to be a homogenous group with stable personalities, demonstrating some minor correlations between personality traits and the quality of postoperative recovery on days 1, 7 and 14. However, further studies are needed.

  • 7.
    Nilsson, Ulrica
    et al.
    Örebro University Hospital, Department of Anaesthesiology and Intensive Care, Örebro, Sweden.
    Unosson, Mitra
    Faculty of Health Science, Department of Medicine and Care, Division of Nursing Science, Linköping, Sweden.
    Rawal, Narinder
    Örebro University Hospital, Department of Clinical Medicine, Division of Anaesthesiology, Örebro, Sweden.
    Stress reduction and analgesia in patients exposed to calming music postoperatively: a randomized controlled trial2005In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 22, no 2, p. 96-102Article in journal (Refereed)
    Abstract [en]

    Background and objectives: This randomized controlled trial was designed to evaluate, first, whether intra- or postoperative music therapy could influence stress and immune response during and after general anaesthesia and second, if there was a different response between patients exposed to music intra- or postoperatively.

    Method: Seventy-five patients undergoing open hernia repair as day care surgery were randomly allocated to three groups: intraoperative music, postoperative music and silence (control group). Anaesthesia and postoperative analgesia were standardized and the same surgeon performed all the operations. Stress response was assessed during and after surgery by determining the plasma cortisol and blood glucose levels. Immune function was evaluated by studying immunoglobulin A (IgA) levels. Patients’ postoperative pain, anxiety, blood pressure (BP), heart rate (HR) and oxygen saturation were also studied as stress markers.

    Results: There was a significantly greater decrease in the level of cortisol in the postoperative music group vs. the control group (206 and 72 mmol L 1 decreases, respectively) after 2 h in the post anaesthesia care unit. The postoperative music group had less anxiety and pain and required less morphine after 1 h compared with the control group. In the postoperative music group the total requirement of morphine was significantly lower than in the control group. The intraoperative music group reported less pain after 1 h in the post anaesthesia care unit. There was no difference in IgA, blood glucose, BP, HR and oxygen saturation between the groups.

    Conclusion: This study suggests that intraoperative music may decrease postoperative pain, and that postoperative music therapy may reduce anxiety, pain and morphine consumption.

  • 8.
    Perniola, Andrea
    et al.
    Department of Anesthesiology and Intensive Care, University Hospital, Örebro.
    Gupta, Anil
    Department of Anesthesiology and Intensive Care, University Hospital, Örebro; Linköping University, Linköping, Sweden.
    Crafoord, Kristina
    Department of Obstetrics and Gynecology, University Hospital, Örebro.
    Darvish, Bijan
    Department of Anesthesiology and Intensive Care, University Hospital, Örebro.
    Magnuson, Anders
    Statistical and Epidemiology Unit, University Hospital, Örebro and.
    Axelsson, Kjell
    Department of Anesthesiology and Intensive Care, University Hospital, Örebro.
    A double-blind dose-finding study of local anesthetics infused intraperitoneally for postoperative pain relief following abdominal hysterectomy.2009In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 26, p. 421-429Article in journal (Refereed)
    Abstract [en]

    Background and objective Local anaesthetics administered intraabdominally have been found to reduce analgesic requirements postoperatively after hysterectomy. This study was designed to assess the optimal dose of local anaesthetics for best pain relief.

    Methods Sixty patients undergoing abdominal hysterectomy were randomly divided into three groups to receive 10 ml hS1 infusion of levobupivacaine intraabdominally postoperatively for 48 h in a double-blind manner: group L, 7.5mghS1; group M, 12.5mghS1 and group H, 17.5mghS1. Pain intensity was measured using the numeric rating scale, ketobemidone consumption over 48 h was measured with a patient controlled analgesia pump, recovery parameters, expiratory muscle strength, time to home readiness, plasma concentration of levobupivacaine and health-related quality of life were all measured at defined time points postoperatively.

    Results No differences were found between the active groups in pain intensity, recovery parameters or healthrelated quality of life. Pain intensity was maximal during 0– 4 h and during coughing. Expiratory muscle strength decreased significantly during 0–4 h in all active groups, with no differences between the groups. Plasma concentration of levobupivacaine was below known toxic concentrations in humans, and no patient had symptoms of local anaesthetic toxicity. Health-related quality of life showed improved scores at 3 months after the operation compared with preoperative values, but no differences between the groups were found in any of the parameters. Conclusion Satisfactory analgesia can be achieved with low doses of levobupivacaine administered intraabdominally, except during the early postoperative period. No advantages were seen in this study when higher doses of levobupivacaine were administered as a continuous infusion for postoperative pain relief. Eur J Anaesthesiol 26:421–429 Q 2009 European Society of Anaesthesiology

  • 9.
    Perniola, Andrea
    et al.
    Örebro University, School of Health and Medical Sciences.
    Gupta, Anil
    Crafoord, Kristina
    Darvish, Bijan
    Magnuson, Anders
    Axelsson, Kjell
    Intraabdominal local anaesthetics for postoperative pain relief following abdominal hysterectomy: a randomized, double-blind, dose-finding study2009In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 26, no 5, p. 421-429Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE: Local anaesthetics administered intraabdominally have been found to reduce analgesic requirements postoperatively after hysterectomy. This study was designed to assess the optimal dose of local anaesthetics for best pain relief.

    METHODS: Sixty patients undergoing abdominal hysterectomy were randomly divided into three groups to receive 10 ml h infusion of levobupivacaine intraabdominally postoperatively for 48 h in a double-blind manner: group L, 7.5 mg h; group M, 12.5 mg h and group H, 17.5 mg h. Pain intensity was measured using the numeric rating scale, ketobemidone consumption over 48 h was measured with a patient-controlled analgesia pump, recovery parameters, expiratory muscle strength, time to home readiness, plasma concentration of levobupivacaine and health-related quality of life were all measured at defined time points postoperatively.

    RESULTS: No differences were found between the active groups in pain intensity, recovery parameters or health-related quality of life. Pain intensity was maximal during 0-4 h and during coughing. Expiratory muscle strength decreased significantly during 0-4 h in all active groups, with no differences between the groups. Plasma concentration of levobupivacaine was below known toxic concentrations in humans, and no patient had symptoms of local anaesthetic toxicity. Health-related quality of life showed improved scores at 3 months after the operation compared with preoperative values, but no differences between the groups were found in any of the parameters.

    CONCLUSION: Satisfactory analgesia can be achieved with low doses of levobupivacaine administered intraabdominally, except during the early postoperative period. No advantages were seen in this study when higher doses of levobupivacaine were administered as a continuous infusion for postoperative pain relief.

  • 10.
    Petrino, Roberta
    et al.
    European Society for Emergency Medicine (EUSEM).
    Dryver, Eric
    EUSEM Education Committee.
    Brown, Ruth
    Emergency Medicine Examination Reference Group for Europe (EMERGE).
    Kurland, Lisa
    UEMS (Union Européenne des Médecins Spécialistes) Section & Board of Emergency Medicine.
    Collaboration in emergency medical care in Europe: the patient is the winner2018In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 35, no 3, p. 237-238Article in journal (Refereed)
  • 11.
    Rawal, Narinder
    et al.
    Örebro University, School of Health and Medical Sciences.
    Langford, R. M.
    Current practices for postoperative pain management in Europe and the potential role of the fentanyl HCl iontophoretic transdermal system2007In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 24, no 4, p. 299-308Article in journal (Refereed)
    Abstract [en]

    Survey results continue to reveal that postoperative pain is insufficiently managed throughout Europe and the rest of the world. However, the efficient use of existing resources, as well as the introduction of novel technologies, may aid in its improvement. Use of an acute pain service has the potential to improve pain management through specialized patient care and utilization of effective analgesic techniques. Multimodal analgesic techniques, which include adjuvant non-opioids and/or regional analgesic techniques, can provide effective analgesia and reduce the amount of systemic opioids (or obviate the need) for postoperative pain management. Patient-controlled analgesia modalities may also offer improvements to pain management, as in practice they provide pain relief superior to the intermittent administration of bolus doses of opioids. A novel patient-controlled analgesia modality that has been approved by the European Medicines Evaluation Agency (EMEA) for the treatment of acute, moderate-to-severe pain is the needle-free, pre-programmed fentanyl HCl iontophoretic transdermal system. This system was shown in a recent US clinical trial to be comparable in efficacy to a standard regimen of morphine intravenous patient-controlled analgesia. Adverse events associated with the use of the fentanyl iontophoretic transdermal system are generally similar to those experienced by patients using intravenous morphine patient-controlled analgesia. Considerations regarding the selection of patients for treatment with the fentanyl iontophoretic transdermal system are similar to those with other patient-controlled analgesia modalities; sufficient upper limb mobility and alertness are required to operate the system. Utilization of the fentanyl iontophoretic transdermal system, together with the guidance of an effective acute pain service, may lead to improvements in postoperative pain management.

  • 12.
    Savilampi, Johanna
    et al.
    Örebro University, School of Medical Sciences. Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Omari, Taher
    Human Physiology, Medical Science and Technology School of Medicine, Flinders University, Adelaide, Australia .
    Magnuson, Anders
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Ahlstrand, Rebecca
    Örebro University, School of Medical Sciences. Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Effects of remifentanil on pharyngeal swallowing: A double blind randomised cross-over study in healthy volunteers2016In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 33, no 9, p. 622-630Article in journal (Refereed)
    Abstract [en]

    Background: Exposure to remifentanil increases the incidence of pulmonary aspiration in healthy volunteers. This effect may be explained by impairment of airway defence mechanisms and/or altered swallowing function. Pressure-flow analysis is a technique that allows objective assessment of swallowing based on pressure-impedance patterns recorded during bolus swallowing.

    Objectives: The aim of this study was to use pressure-flow analysis to quantify the effect of remifentanil on healthy pharyngeal swallowing and to compare these effects with morphine.

    Design: A double-blind, randomised, cross-over study.

    Setting: A tertiary care teaching hospital.

    Volunteers: Eleven young volunteers (mean age, 23 years) and seven older volunteers (mean age, 73 years).

    Interventions: Volunteers were studied twice and received either a target-controlled remifentanil infusion (target concentrations: young, 3 ng ml; old, 2 ng ml) or a bolus injection of morphine (dose: young, 0.1 mg kg; old, 0.07 mg kg). Pharyngeal pressure and impedance were recorded with an indwelling catheter while swallowing 10 boluses of liquid during each measuring phase. Variables defining swallowing function were calculated and compared to determine drug effects.

    Main outcome measures: Pharyngeal pressure-flow variables following remifentanil exposure.

    Results: Changes produced by remifentanil in the measured variables were consistent with greater dysfunction of swallowing. Both the strength of the pharyngeal contractions and pharyngeal bolus propulsion were reduced, whereas flow resistance was increased. The swallow risk index, a global index of swallowing dysfunction, increased overall. At the experimental doses tested, morphine produced similar, but less extensive effects on swallowing.

    Conclusion: Remifentanil induced dysfunction of the pharyngeal swallowing mechanism. This may contribute to an increased risk of aspiration.

    Trial registration: NCT01924234

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