• Anna I Hårdemark Cedborg, Eva Sundman, Katarina Bodén, Hanne Witt Hedström, Richard Kuylenstierna, Olle Ekberg, and Lars I Eriksson.
• From the Department of Anesthesia, Surgical Services, and Intensive Care (A.I.H.C., E.S., L.I.E.), Department of Diagnostic Radiology (K.B.), Department of Neuroradiology (H.W.H.), Department of Oto- Rhino- Laryngology (R.K.), Karolinska University Hospital, Stockholm, Sweden; the Department of Physiology and Pharmacology (A.I.H.C., E.S., L.I.E.), Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden; and the Department of Diagnostic Radiology (O.E.), Malmö University Hospital, Malmö, Sweden.
• Anesthesiology. 2014 Feb 1;120(2):312-25.

BackgroundIntact pharyngeal function and coordination of breathing and swallowing are essential for airway protection and to avoid respiratory complications. Postoperative pulmonary complications caused by residual effects of neuromuscular-blocking agents occur more frequently in the elderly. Moreover, elderly have altered pharyngeal function which is associated with increased risk of aspiration. The purpose of this study was to evaluate effects of partial neuromuscular block on pharyngeal function, coordination of breathing and swallowing, and airway protection in individuals older than 65 yr.MethodsPharyngeal function and coordination of breathing and swallowing were assessed by manometry and videoradiography in 17 volunteers, mean age 73.5 yr. After control recordings, rocuronium was administered to obtain steady-state train-of-four ratios of 0.70 and 0.80 followed by spontaneous recovery to greater than 0.90.ResultsPharyngeal dysfunction increased significantly at train-of-four ratios 0.70 and 0.80 to 67 and 71%, respectively, compared with 37% at control recordings, and swallowing showed a more severe degree of dysfunction during partial neuromuscular block. After recovery to train-of-four ratio of greater than 0.90, pharyngeal dysfunction was not significantly different from the control state. Resting pressure in the upper esophageal sphincter was lower at all levels of partial neuromuscular block compared with control recordings. The authors were unable to demonstrate impaired coordination of breathing and swallowing.ConclusionPartial neuromuscular block in healthy elderly individuals causes an increased incidence of pharyngeal dysfunction from 37 to 71%, with impaired ability to protect the airway; however, the authors were unable to detect an effect of partial neuromuscular block on coordination of breathing and swallowing.

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