Effects of Morphine and Midazolam on Pharyngeal Function, Airway Protection, and Coordination of Breathing and Swallowing in Healthy Adults

被引:42
作者
Cedborg, Anna I. Hardemark [1 ,6 ]
Sundman, Eva [1 ,6 ]
Boden, Katarina [2 ,6 ]
Hedstroem, Hanne Witt [3 ,6 ]
Kuylenstierna, Richard [4 ,6 ]
Ekberg, Olle [5 ]
Eriksson, Lars I. [1 ,6 ]
机构
[1] Karolinska Univ Hosp, Dept Anesthesia Surg Serv & Intens Care, S-17176 Stockholm, Sweden
[2] Karolinska Univ Hosp, Dept Diagnost Radiol, S-17176 Stockholm, Sweden
[3] Karolinska Univ Hosp, Dept Neuroradiol, S-17176 Stockholm, Sweden
[4] Karolinska Univ Hosp, Dept Otorhinolaryngol, S-17176 Stockholm, Sweden
[5] Malmo Univ Hosp, Diagnost Radiol, Malmo, Sweden
[6] Karolinska Inst, Dept Physiol & Pharmacol, Sect Anesthesiol & Intens Care Med, Stockholm, Sweden
基金
瑞典研究理事会;
关键词
HYPOGLOSSAL NERVE ACTIVITY; PARTIALLY PARALYZED HUMANS; ESOPHAGEAL SPHINCTER; ASPIRATION PNEUMONIA; PRESSURE; REFLEX; ANESTHESIA; PROPOFOL; VIDEORADIOGRAPHY; INDIVIDUALS;
D O I
10.1097/ALN.0000000000000657
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: Drugs used for sedation in anesthesia and intensive care may cause pharyngeal dysfunction and increased risk for aspiration. In this study, the authors investigate the impact of sedative doses of morphine and midazolam on pharyngeal function during swallowing and coordination of breathing and swallowing. Methods: Pharyngeal function, coordination of breathing and swallowing, and level of sedation were assessed by manometry, videoradiography, measurements of respiratory airflow, and a visual analog scale in 32 healthy volunteers (age 19 to 35 yr). After baseline recordings, morphine (0.1 mg/kg) or midazolam (0.05 mg/kg) was administered intravenously for 20 min, followed by recordings at 10 and 30 min after the end of infusion. Results: Pharyngeal dysfunction, seen as misdirected or incomplete swallowing or penetration of bolus to the airway, increased after morphine infusion to 42 and 44% of swallows compared with 17% in baseline recordings. Midazolam markedly increased incidence of pharyngeal dysfunction from 16 to 48% and 59%. Morphine prolonged apnea before swallowing, and midazolam increased the number of swallows followed by inspiration. Conclusion: Morphine and midazolam in dosages that produce sedation are associated with increased incidence of pharyngeal dysfunction and discoordinated breathing and swallowing, a combination impairing airway protection and potentially increasing the risk for pulmonary aspirations.
引用
收藏
页码:1253 / 1267
页数:15
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