• Johanna Savilampi, Taher Omari, Anders Magnuson, and Rebecca Ahlstrand.
• From the Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Örebro University, Örebro, Sweden (JS, RA); Human Physiology, Medical Science and Technology School of Medicine, Flinders University, South Australia (TO); and Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden (AM).
• Eur J Anaesthesiol. 2016 Sep 1; 33 (9): 622-30.

BackgroundExposure 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.ObjectivesThe 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.DesignA double-blind, randomised, cross-over study.SettingA tertiary care teaching hospital.VolunteersEleven young volunteers (mean age, 23 years) and seven older volunteers (mean age, 73 years).InterventionsVolunteers 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 MeasuresPharyngeal pressure-flow variables following remifentanil exposure.ResultsChanges 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.ConclusionRemifentanil induced dysfunction of the pharyngeal swallowing mechanism. This may contribute to an increased risk of aspiration.Trial RegistrationNCT01924234 (www.clinicaltrials.gov).

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