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  • 1.
    Ahlstrand, Rebecca
    et al.
    Örebro universitet, Hälsoakademin. Department of Anesthesiology and Intensive Care.
    Savilampi, Johanna
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Thörn, Sven-Egron
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Wattwil, Magnus
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Effects of cricoid pressure and remifentanil on the esophageal sphincters using high-resolution solid-state manometry2011Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 55, nr 2, s. 209-215Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Cricoid pressure has been shown to decrease the pressure in the lower esophageal sphincter (LES), increasing the risk of aspiration. Whether this reaction is due to pain associated with the application of cricoid pressure has not been studied. The aim of this study was to compare the effects of cricoid pressure with those of peripheral pain on pressures in the LES, and to study whether remifentanil influences these effects. Data from the upper esophageal sphincter (UES) are also described.

    METHODS: Continuous solid-state manometry was performed in 14 healthy volunteers. Initially, the effect of remifentanil (target-controlled infusion with a plasma target concentration of 5.0 ng/ml) was studied, and thereafter, the effects of cricoid pressure and peripheral pain stimulation (cold stimulation). Finally, these two interventions were repeated under ongoing remifentanil infusion.

    RESULTS: Remifentanil decreased the LES pressure significantly [ΔP-6.5 mmHg, 95% confidence interval (95% CI) -1.7 to -11.2]. Cricoid pressure application decreased the LES pressure significantly (ΔP-3.7 mmHg, 95% CI -1.4 to 6.1), whereas peripheral pain did not (ΔP 1.2 mmHg, 95% CI -3.5 to 1.1). Under ongoing remifentanil infusion, no cricoid pressure-induced LES relaxation was observed. Cricoid pressure induced high pressures in the area of the UES, 215.7 (±91.2) mmHg without remifentanil vs. 219.4 (±74.2) mmHg with remifentanil.

    CONCLUSIONS: Remifentanil as well as cricoid pressure per se induced decreases in LES pressure. However, cricoid pressure-induced changes of the barrier pressure were not significant whether induced with or without an infusion of remifentanil.

  • 2.
    Cock, C.
    et al.
    Gastroenterology & Hepatology, Flinders Medical Centre, Bedford Park SA, Australia; School of Medicine, Flinders University of South Australia, Adelaide, Australia.
    Doeltgen, S. H.
    Speech Pathology, School of Health Sciences, Flinders University of South Australia, Adelaide, Australia.
    Omari, T.
    School of Medicine, Flinders University of South Australia, Adelaide, Australia; Human Physiology, Medical Science and Technology, Flinders University of South Australia, Adelaide, Australia.
    Savilampi, Johanna
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Effects of remifentanil on esophageal and esophagogastric junction (EGJ) bolus transit in healthy volunteers using novel pressure-flow analysis2018Ingår i: Neurogastroenterology and Motility, ISSN 1350-1925, E-ISSN 1365-2982, Vol. 30, nr 2, artikel-id e13191Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Remifentanil is associated with subjective dysphagia and an objective increase in aspiration risk. Studies of opioid effects have shown decreased lower esophageal sphincter relaxation. We assessed bolus transit through the esophagus and esophagogastric junction (EGJ) during remifentanil administration using objective pressure-flow analysis.

    METHODS: Data from 11 healthy young participants (23±3 years, 7 M) were assessed for bolus flow through the esophagus and EGJ using high-resolution impedance manometry (Manoscan™, Sierra Scientific Instruments, Inc., LES Angeles, CA, USA) with 36 pressure and 18 impedance segments. Data were analyzed for esophageal pressure topography and pressure-flow analysis using custom Matlab analyses (Mathworks, Natick, USA). Paired t tests were performed with a P-value of < .05 regarded as significant.

    KEY RESULTS: Duration of bolus flow through (remifentanil/R 3.0±0.3 vs baseline/B 5.0 ± 0.4 seconds; P < .001) and presence at the EGJ (R 5.1 ± 0.5 vs B 7.1 ± 0.5 seconds; P = .001) both decreased during remifentanil administration. Distal latency (R 5.2 ± 0.4 vs B 7.5 ± 0.2 seconds; P < .001) and distal esophageal distension-contraction latency (R 3.5 ± 0.1 vs B 4.7 ± 0.2 seconds; P < .001) were both reduced. Intrabolus pressures were increased in both the proximal (R 5.3 ± 0.9 vs B 2.6 ± 1.3 mm Hg; P = .01) and distal esophagus (R 8.6 ± 1.7 vs B 3.1 ± 0.8 mm Hg; P = .001). There was no evidence of increased esophageal bolus residue.

    CONCLUSIONS AND INFERENCES: Remifentanil-induced effects were different for proximal and distal esophagus, with a reduced time for trans-sphincteric bolus flow at the EGJ, suggestive of central and peripheral μ-opioid agonism. There were no functional consequences in healthy subjects.

  • 3.
    Cock, C.
    et al.
    Department of Gastroenterology & Surgery, Flinders University, Adelaide, Australia.
    Doeltgen, S.
    Department of Speech Pathology, Flinders University, Adelaide, Australia.
    Omari, T. I.
    Department of Gastroenterology & Surgery, Flinders University, Adelaide, Australia; Department of Human Physiology, Flinders University, Adelaide, Australia .
    Savilampi, Johanna
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Remifentanil induced changes in esophageal and esophagogastric junction (EGJ) bolus transport in healthy volunteers2016Ingår i: Neurogastroenterology and Motility, ISSN 1350-1925, E-ISSN 1365-2982, Vol. 28, nr S1, s. 68-68Artikel i tidskrift (Övrigt vetenskapligt)
  • 4.
    Doeltgen, Sebastian H.
    et al.
    Speech Pathology and Audiology, School of Health Sciences, Flinders University, Adelaide, Australia.
    Omari, Taher I.
    Human Physiology, Medical Science and Technology, School of Medicine, Flinders University, Adelaide, Australia.
    Savilampi, Johanna
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Remifentanil alters sensory neuromodulation of swallowing in healthy volunteers: Quantification by a novel pressure-impedance analysis2016Ingår i: American Journal of Physiology - Gastrointestinal and Liver Physiology, ISSN 0193-1857, E-ISSN 1522-1547, Vol. 310, nr 11, s. G1176-G1182Artikel i tidskrift (Refereegranskat)
    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.

  • 5.
    Milton, A.
    et al.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
    Schandl, A.
    Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Soliman, I. W.
    Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
    Meijers, K.
    Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden.
    van den Boogaard, M.
    Department of Intensive Care Medicine, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands.
    Larsson, I. M.
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Brorsson, C.
    Department of Surgery and Perioperative Science, Umeå University, Umeå, Sweden.
    Östberg, U.
    Department of Anaesthesiology and Intensive Care, Östersund Hospital, Östersund, Sweden.
    Oxenbøll-Collet, M.
    Department of Intensive Care, Rigshospitalet Copenhagen, Copenhagen, Denmark.
    Savilampi, Johanna
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Anaesthesiology and Intensive Care.
    Paskins, S.
    Department of Intensive Care, Odense University Hospital, Odense, Denmark.
    Bottai, M.
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Sackey, P. V.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Development of an ICU discharge instrument predicting psychological morbidity: a multinational study2018Ingår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 44, nr 12, s. 2038-2047Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To develop an instrument for use at ICU discharge for prediction of psychological problems in ICU survivors.

    Methods: Multinational, prospective cohort study in ten general ICUs in secondary and tertiary care hospitals in Sweden, Denmark and the Netherlands. Adult patients with an ICU stay12h were eligible for inclusion. Patients in need of neurointensive care, with documented cognitive impairment, unable to communicate in the local language, without a home address or with more than one limitation of therapy were excluded. Primary outcome was psychological morbidity 3months after ICU discharge, defined as Hospital Anxiety and Depression Scale (HADS) subscale score11 or Post-traumatic Stress Symptoms Checklist-14 (PTSS-14) part B score>45.

    Results: A total of 572 patients were included and 78% of patients alive at follow-up responded to questionnaires. Twenty percent were classified as having psychological problems post-ICU. Of 18 potential risk factors, four were included in the final prediction model after multivariable logistic regression analysis: symptoms of depression [odds ratio (OR) 1.29, 95% confidence interval (CI) 1.10-1.50], traumatic memories (OR 1.44, 95% CI 1.13-1.82), lack of social support (OR 3.28, 95% CI 1.47-7.32) and age (age-dependent OR, peak risk at age 49-65years). The area under the receiver operating characteristics curve (AUC) for the instrument was 0.76 (95% CI 0.70-0.81).

    Conclusions: We developed an instrument to predict individual patients' risk for psychological problems 3months post-ICU, http://www.imm.ki.se/biostatistics/calculators/psychmorb/. The instrument can be used for triage of patients for psychological ICU follow-up.

    Trial registration: The study was registered at clinicaltrials.gov, NCT02679157.

  • 6.
    Milton, Anna
    et al.
    Dept. of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Dept. of Perioperative Medicine and Intensive care, Karolinska University Hospital, Stockholm, Sweden.
    Schandl, Anna
    Dept. of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Soliman, Iwo
    Dept. of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
    Joelsson-Alm, Eva
    Dept. of Clinical Science and Education, Karolinska Institutet and Unit of Anaesthesiology and Intensive care, Södersjukhuset, Stockholm, Sweden.
    van den Boogaard, Mark
    Dept. of Intensive Care Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
    Wallin, Ewa
    Dept. of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
    Brorsson, Camilla
    Dept. of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
    Östberg, Ulrika
    Dept. of Anaesthesiology and Intensive care, Östersund Hospital, Östersund, Sweden.
    Latocha, Kristine
    Dept of Intensive Care, Rigshospitalet, Copenhagen, Denmark.
    Savilampi, Johanna
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Dept. of Anaesthesiology and Intensive care.
    Paskins, Stinne
    Dept of Intensive care, Odense University Hospital, Odense, Denmark.
    Bottai, Matteo
    Institute of Environmental Medicine Karolinska Institutet, Stockholm, Sweden.
    Sackey, Peter
    Dept. of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    ICU discharge screening for prediction of new-onset physical disability - a multinational cohort study2020Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Methods to identify patients at risk for incomplete physical recovery after intensive care unit (ICU) stay are lacking. Our aim was to develop a method for prediction of new-onset physical disability at ICU discharge.

    METHODS: Multinational prospective cohort study in ten general ICUs in Sweden, Denmark and the Netherlands. Adult patients with an ICU stay ≥12 hours were eligible for inclusion. Sixteen candidate predictors were analyzed with logistic regression for associations with the primary outcome; new-onset physical disability three months post-ICU, defined as a ≥10 score reduction in the Barthel Index compared to baseline.

    RESULTS: Of 572 included patients, follow-up data are available on 78% of patients alive at follow-up. The incidence of new-onset physical disability was 19%. Univariable and multivariable modeling rendered one sole predictor for the outcome: physical status at ICU discharge, assessed with the five first items of the Chelsea Critical Care Physical Assessment Tool (CPAx) (odds ratio 0.87, 95% confidence interval (CI) 0.81 to 0.93), a higher score indicating a lower risk, with an area under the receiver operating characteristics curve of 0.68 (95% CI 0.61 to 0.76). Negative predictive value for a low-risk group (CPAx score >18) was 0.88, positive predictive value for a high-risk group (CPAx score ≤18) was 0.32.

    CONCLUSION: The ICU discharge assessment described in this study had a moderate AUC but may be useful to rule out patients unlikely to need physical interventions post-ICU. For high-risk patients, research to determine post-ICU risk factors for an incomplete rehabilitation is mandated.

  • 7.
    Savilampi, Johanna
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Effects of remifentanil on esophageal sphincters and swallowing function2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Delarbeten
    1. Effects of remifentanil on the esophagogastric junction and swallowing
    Öppna denna publikation i ny flik eller fönster >>Effects of remifentanil on the esophagogastric junction and swallowing
    2013 (Engelska)Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 57, nr 8, s. 1002-1009Artikel i tidskrift (Refereegranskat) 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.

    Nyckelord
    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
    Nationell ämneskategori
    Anestesi och intensivvård
    Forskningsämne
    Anestesiologi
    Identifikatorer
    urn:nbn:se:oru:diva-38729 (URN)10.1111/aas.12134 (DOI)000323075000008 ()23713743 (PubMedID)2-s2.0-84881666944 (Scopus ID)
    Anmärkning

    Funding agencieas are:

    Wyeth AB, Solna, Sweden

    Orebro County Council

    Tillgänglig från: 2014-11-18 Skapad: 2014-11-18 Senast uppdaterad: 2018-08-27Bibliografiskt granskad
    2. Aspiration Induced by Remifentanil: A Double-blind, Randomized, Crossover Study in Healthy Volunteers
    Öppna denna publikation i ny flik eller fönster >>Aspiration Induced by Remifentanil: A Double-blind, Randomized, Crossover Study in Healthy Volunteers
    Visa övriga...
    2014 (Engelska)Ingår i: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 121, nr 1, s. 52-58Artikel i tidskrift (Refereegranskat) 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.

    Ort, förlag, år, upplaga, sidor
    Lippincott Williams & Wilkins, 2014
    Nationell ämneskategori
    Anestesi och intensivvård
    Forskningsämne
    Medicin
    Identifikatorer
    urn:nbn:se:oru:diva-35818 (URN)10.1097/ALN.0000000000000202 (DOI)000337758500010 ()24598216 (PubMedID)2-s2.0-84902874808 (Scopus ID)
    Anmärkning

    Funding Agency:

    Research Fund of the Örebro County Council, Örebro, Sweden

    Tillgänglig från: 2014-08-27 Skapad: 2014-07-30 Senast uppdaterad: 2018-06-09Bibliografiskt granskad
    3. Effects of remifentanil on esophageal motility: A double blind, randomized, cross-over study in healthy volunteers
    Öppna denna publikation i ny flik eller fönster >>Effects of remifentanil on esophageal motility: A double blind, randomized, cross-over study in healthy volunteers
    2015 (Engelska)Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, nr 9, s. 1126-1136Artikel i tidskrift (Refereegranskat) 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.

    Nationell ämneskategori
    Anestesi och intensivvård
    Forskningsämne
    Anestesiologi
    Identifikatorer
    urn:nbn:se:oru:diva-44661 (URN)10.1111/aas.12534 (DOI)000360982900006 ()25923045 (PubMedID)2-s2.0-84941254659 (Scopus ID)
    Anmärkning

    Funding Agency:

    Örebro County Council

    Tillgänglig från: 2015-05-20 Skapad: 2015-05-20 Senast uppdaterad: 2018-06-30Bibliografiskt granskad
    4. Effects of Remifentanil and Morphine on Pharyngeal Swallowing: A Double Blind Randomized Cross-over Study in Healthy Volunteers
    Öppna denna publikation i ny flik eller fönster >>Effects of Remifentanil and Morphine on Pharyngeal Swallowing: A Double Blind Randomized Cross-over Study in Healthy Volunteers
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Anestesi och intensivvård
    Identifikatorer
    urn:nbn:se:oru:diva-44663 (URN)
    Tillgänglig från: 2015-05-20 Skapad: 2015-05-20 Senast uppdaterad: 2017-10-17Bibliografiskt granskad
    Ladda ner fulltext (pdf)
    Introductory chapter
    Ladda ner (pdf)
    Cover
    Ladda ner (pdf)
    Spikblad
  • 8.
    Savilampi, Johanna
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län.
    Ahlstrand, Rebecca
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län.
    Geijer, Håkan
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län.
    Wattwil, Magnus
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Örebro University Hospital, Örebro, Sweden.
    Aspiration during monitored anesthesia care reply2015Ingår i: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 122, nr 2, s. 472-472Artikel i tidskrift (Refereegranskat)
  • 9.
    Savilampi, Johanna
    et al.
    Örebro university, Örebro, Sweden.
    Ahlstrand, Rebecca
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Magnuson, Anders
    Örebro university, Örebro, Sweden.
    Effects of remifentanil on pharyngeal swallowing: a double blind, randomized, cross-over study in healthy volunteers2015Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, s. 46-46Artikel i tidskrift (Övrigt vetenskapligt)
  • 10.
    Savilampi, Johanna
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Ahlstrand, Rebecca
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden; Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistic Unit, Örebro University Hospital, Örebro, Sweden.
    Geijer, Håkan
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Wattwil, Magnus
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Aspiration Induced by Remifentanil: A Double-blind, Randomized, Crossover Study in Healthy Volunteers2014Ingår i: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 121, nr 1, s. 52-58Artikel i tidskrift (Refereegranskat)
    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.

  • 11.
    Savilampi, Johanna
    et al.
    Region Örebro län. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Ahlstrand, Rebecca
    Region Örebro län. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Magnuson, Anders
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden .
    Wattwil, Magnus
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden .
    Effects of remifentanil on the esophagogastric junction and swallowing2013Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 57, nr 8, s. 1002-1009Artikel i tidskrift (Refereegranskat)
    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.

  • 12.
    Savilampi, Johanna
    et al.
    Region Örebro län. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Magnusson, Anders
    Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Ahlstrand, Rebecca
    Region Örebro län. Department of Anesthesiology and Intensive CareDepartment of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Effects of remifentanil on esophageal motility: A double blind, randomized, cross-over study in healthy volunteers2015Ingår i: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 59, nr 9, s. 1126-1136Artikel i tidskrift (Refereegranskat)
    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.

  • 13.
    Savilampi, Johanna
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. 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 universitet, Institutionen för medicinska vetenskaper. 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 volunteers2016Ingår i: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 33, nr 9, s. 622-630Artikel i tidskrift (Refereegranskat)
    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

  • 14.
    Savilampi, Johanna
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Örebro University Hospital, Örebro, Sweden.
    Omari, Taher
    Human Physiology, Medical Science and Technology School of Medicine, Flinders University, South Australia.
    Magnusson, Anders
    Örebro County, Örebro, Sweden.
    Ahlstrand, Rebecca
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Örebro University Hospital, Örebro, Sweden.
    Effects of Remifentanil and Morphine on Pharyngeal Swallowing: A Double Blind Randomized Cross-over Study in Healthy VolunteersManuskript (preprint) (Övrigt vetenskapligt)
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