Pharyngeal Function and Airway Protection During Subhypnotic Concentrations of Propofol, Isoflurane, and Sevoflurane

2001 ◽  
Vol 95 (5) ◽  
pp. 1125-1132 ◽  
Author(s):  
Eva Sundman ◽  
Hanne Witt ◽  
Rolf Sandin ◽  
Richard Kuylenstierna ◽  
Katarina Bodén ◽  
...  
Keyword(s):  
Time Pressure ◽  
Upper Esophageal Sphincter ◽  
Airway Protection ◽  
Bolus Transit ◽  
Anesthetic Agents ◽  
Esophageal Sphincter ◽  
Contrast Bolus ◽  
Pharyngeal Constrictor Muscles ◽  
Resting Tone ◽  
Pharyngeal Function

Background Anesthetic agents alter pharyngeal function with risk of impaired airway protection and aspiration. This study was performed to evaluate pharyngeal function during subhypnotic concentrations of propofol, isoflurane, and sevoflurane and to compare the drugs for possible differences in this respect. Methods Forty-five healthy volunteers were randomized to receive propofol, isoflurane, or sevoflurane. During series of liquid contrast bolus swallowing, fluoroscopy and simultaneous solid state videomanometry was used to study the incidence of pharyngeal dysfunction, the initiation of swallowing, and the bolus transit time. Pressure changes were recorded at the back of the tongue, the pharyngeal constrictor muscles, and the upper esophageal sphincter. After control recordings, the anesthetic was delivered, and measurements were made at 0.50 and 0.25 predicted blood propotol concentration (Cp50(asleep)) for propofol and 0.50 and 0.25 minimum alveolar concentration (MAC)(awake) for the inhalational agents. Final recordings were made 20 min after the end of anesthetic delivery. Results All anesthetics caused an increased incidence of pharyngeal dysfunction with laryngeal bolus penetration. Propofol increased the incidence from 8 to 58%, isoflurane from 4 to 36%, and sevoflurane from 6 to 35%. Propofol in 0.50 and 0.25 Cp50(asleep) had the most extensive effect on the pharyngeal contraction patterns (P < 0.05). The upper esophageal sphincter resting tone was markedly reduced from 83 +/- 36 to 39 +/- 19 mmHg by propofol (P < 0.001), which differed from isoflurane (P = 0.03). Sevoflurane also reduced the upper esophageal sphincter resting tone from 65 +/- 16 to 45 +/- 18 mmHg at 0.50 MAC(awake)(P = 0.008). All agents caused a reduced upper esophageal sphincter peak contraction amplitude (P < 0.05), and the reduction was greatest in the propofol group (P = 0.002). Conclusion Subhypnotic concentrations of propofol, isoflurane, and sevoflurane cause an increased incidence of pharyngeal dysfunction with penetration of bolus to the larynx. The effect on the pharyngeal contraction pattern was most pronounced in the propofol group, with markedly reduced contraction forces.

Functional Assessment of the Pharynx at Rest and during Swallowing in Partially Paralyzed Humans 

1997 ◽  
Vol 87 (5) ◽  
pp. 1035-1043 ◽  
Author(s):  
Lars I. Eriksson ◽  
Eva Sundman ◽  
Rolf Olsson ◽  
Lena Nilsson ◽  
Hanne Witt ◽  
...  
Keyword(s):  
Muscle Function ◽  
Upper Esophageal Sphincter ◽  
Adductor Pollicis ◽  
Sphincter Muscle ◽  
Muscle Coordination ◽  
Bolus Transit ◽  
Constrictor Muscle ◽  
Esophageal Sphincter ◽  
Resting Tone ◽  
Pharyngeal Function

Background Functional characteristics of the pharynx and upper esophagus, including aspiration episodes, were investigated in 14 awake volunteers during various levels of partial neuromuscular block. Pharyngeal function was evaluated using videoradiography and computerized pharyngeal manometry during contrast bolus swallowing. Methods Measurements of pharyngeal constrictor muscle function (contraction amplitude, duration, and slope), upper esophageal sphincter muscle resting tone, muscle coordination, bolus transit time, and aspiration under fluoroscopic control (laryngeal or tracheal penetration) were made before (control measurements) and during a vecuronium-induced partial neuromuscular paralysis, at fixed intervals of mechanical adductor pollicis muscle train-of-four (TOF) fade; that is, at TOF ratios of 0.60, 0.70, 0.80, and after recovery to a TOF ratio > 0.90. Results Six volunteers aspirated (laryngeal penetration) at a TOF ratio < 0.90. None of them aspirated at a TOF ratio > 0.90 or during control recording. Pharyngeal constrictor muscle function was not affected at any level of paralysis. The upper esophageal sphincter resting tone was significantly reduced at TOF ratios of 0.60, 0.70, and 0.80 (P < 0.05). This was associated with reduced muscle coordination and shortened bolus transit time at a TOF ratio of 0.60. Conclusions Vecuronium-induced partial paralysis cause pharyngeal dysfunction and increased risk for aspiration at mechanical adductor pollicis TOF ratios < 0.90. Pharyngeal function is not normalized until an adductor pollicis TOF ratio of > 0.90 is reached. The upper esophageal sphincter muscle is more sensitive to vecuronium than is the pharyngeal constrictor muscle.

The Incidence and Mechanisms of Pharyngeal and Upper Esophageal Dysfunction in Partially Paralyzed Humans

2000 ◽  
Vol 92 (4) ◽  
pp. 977-984 ◽  
Author(s):  
Eva Sundman ◽  
Hanne Witt ◽  
Rolf Olsson ◽  
Olle Ekberg ◽  
Richard Kuylenstierna ◽  
...  
Keyword(s):  
Transit Time ◽  
Neuromuscular Block ◽  
Upper Esophageal Sphincter ◽  
Bolus Transit ◽  
Laryngeal Penetration ◽  
Train Of Four ◽  
Swallowing Reflex ◽  
Esophageal Sphincter ◽  
Pharyngeal Constrictor Muscles ◽  
Pharyngeal Function

Background Residual neuromuscular block caused by vecuronium alters pharyngeal function and impairs airway protection. The primary objectives of this investigation were to radiographically evaluate the swallowing act and to record the incidence of and the mechanism behind pharyngeal dysfunction during partial neuromuscular block. The secondary objective was to evaluate the effect of atracurium on pharyngeal function. Methods Twenty healthy volunteers were studied while awake during liquid-contrast bolus swallowing. The incidence of pharyngeal dysfunction was studied by fluoroscopy. The initiation of the swallowing process, the pharyngeal coordination, and the bolus transit time were evaluated. Simultaneous manometry was used to document pressure changes at the tongue base, the pharyngeal constrictor muscles, and the upper esophageal sphincter. After control recordings, an intravenous infusion of atracurium was administered to obtain train-of-four ratios (T4/T1) of 0.60, 0.70, and 0.80, followed by recovery to a train-of-four ratio of more than 0.90. Results The incidence of pharyngeal dysfunction was 6% during the control recordings and increased (P < 0.05) to 28%, 17%, and 20% at train-of-four ratios 0.60, 0.70, and 0.80, respectively. After recovery to a train-of-four ratio of more than 0.90, the incidence was 13%. Pharyngeal dysfunction occurred in 74 of 444 swallows, the majority (80%) resulting in laryngeal penetration. The initiation of the swallowing reflex was impaired during partial paralysis (P = 0.0081). The pharyngeal coordination was impaired at train-of-four ratios of 0.60 and 0.70 (P < 0.01). A marked reduction in the upper esophageal sphincter resting tone was found, as well as a reduced contraction force in the pharyngeal constrictor muscles. The bolus transit time did not change significantly. Conclusion Partial neuromuscular paralysis caused by atracurium is associated with a four- to fivefold increase in the incidence of misdirected swallowing. The mechanism behind the pharyngeal dysfunction is a delayed initiation of the swallowing reflex, impaired pharyngeal muscle function, and impaired coordination. The majority of misdirected swallows resulted in penetration of bolus to the larynx.

The Cricopharyngeus in the Neonate

1980 ◽  
Vol 89 (5) ◽  
pp. 446-449 ◽  
Author(s):  
Timothy J. Reichert ◽  
Kenneth D. Faw
Keyword(s):  
Upper Esophageal Sphincter ◽  
Airway Protection ◽  
Sphincter Function ◽  
Cricopharyngeus Muscle ◽  
Total Length ◽  
Esophageal Sphincter ◽  
Neonates And Infants

The cricopharyngeus muscle in neonates and infants has not been well established. It is found, like other laryngopharyngeal structures in infants, to be relatively much larger than its counterpart in the adult but not large enough to correlate with the total length of reported sphincter function. It also varies significantly in size, and therefore probably does not contribute completely to the function of the upper esophageal sphincter. Its relationship to airway protection, regurgitation and respiration needs to be more thoroughly studied.

Effects of Head Rotation on Pharyngeal Function during Normal Swallow

1998 ◽  
Vol 107 (4) ◽  
pp. 344-348 ◽  
Author(s):  
Yukio Ohmae ◽  
Masami Ogura ◽  
Satoshi Kitahara ◽  
Takehiro Karaho ◽  
Tetsuzo Inouye
Keyword(s):  
Healthy Subjects ◽  
Head Rotation ◽  
Normal Subjects ◽  
Upper Esophageal Sphincter ◽  
Resting Pressure ◽  
Esophageal Sphincter ◽  
Pharyngeal Clearance ◽  
Pharyngeal Swallowing ◽  
Peak Pressures ◽  
Pharyngeal Function

This study quantified the effects of head rotation on pharyngeal swallowing in healthy subjects. Videofluoroscopic and oropharyngeal manometric examinations of pharyngeal swallowing were performed on seven volunteers with the head in neutral and rotated positions. Videofluoroscopic study revealed that head rotation swallow causes the bolus to lateralize away from the direction of head rotation. Pharyngeal manometric study indicated that the pharyngeal peak pressures toward the side of head rotation were significantly increased, whereas the pharyngeal pressures opposite the side of head rotation were not affected. Head rotation swallow produced a significant fall in upper esophageal sphincter (UES) resting pressure and a delay in UES closing. We concluded that the head rotation swallow in normal subjects not only alters the bolus pathway, but also has a useful effect on both pharyngeal clearance and UES dynamics.

Dysphagia among patients after total laryngectomy: diagnostic and therapeutic procedures

2020 ◽  
Vol 9 (4) ◽  
pp. 1-5
Author(s):  
Barbara Jamróz ◽  
Joanna Chmielewska-Walczak ◽  
Magdalna Milewska
Keyword(s):  
Total Laryngectomy ◽  
Speech Therapy ◽  
Botulinum Toxin Injection ◽  
Specific Treatment ◽  
Upper Esophageal Sphincter ◽  
Diagnostic Process ◽  
Bolus Transit ◽  
Surgical Methods ◽  
Pharyngeal Plexus ◽  
Esophageal Sphincter

Dysphagia concerns 10–89% patients after total laryngectomy; to a greater extent, it concerns patients receiving complementary radiotherapy. The disease mechanism is associated with anatomical changes after surgery (scope of surgery) or complications of adjuvant therapy (xerostomia, neuropathy, swelling of tissue, etc.). The above changes lead to: decreased mobility of the lateral walls of the pharynx and tongue retraction, the occurrence of lingual pumping, decreased swallowing reflex, weakening of the upper esophageal sphincter opening, contraction of the cricopharyngeal muscle, tissue fibrosis, formation of pharyngeal pseudodiverticulum, etc. As a result: regurgitation of food through the nose and oral cavity, food sticking in middle and lower pharynx, prolongation of bolus transit time. Upon the formation of tracheoesophageal fistula, there may be aspiration of gastric contents. The above changes considerably reduce patients’ quality of life after surgery. The diagnostic protocol includes: medical interview (questionnaires can be helpful such as: EAT 10, SSQ, MDADI, DHI), clinical swallowing assessment and instrumental examinations: primarily videofluoroscopy but also endoscopic evaluation of swallowing. In selected cases, multifrequency manometry is necessary. The treatment options include: surgical methods (e.g. balloon dilatation of the upper esophageal sphincter, cricopharyngeal myotomy, pharyngeal plexus neurectomy, removal of the pharyngeal pseudodiverticulum), conservative methods (e.g. botulinum toxin injection of the upper esophageal sphincter, speech therapy, nutritional treatment) and supportive methods such as consultation with a psychologis physiotherapist, clinical dietitian. The selection of a specific treatment method should be preceded by a diagnostic process in which the mechanism of functional disorders related to voice formation and swallowing will be established.

scholarly journals Bolus transit of upper esophageal sphincter on high-resolution impedance manometry study correlate with the laryngopharyngeal reflux symptoms

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jia-Feng Wu ◽  
Wei-Chung Hsu ◽  
I.-Jung Tsai ◽  
Tzu-Wei Tong ◽  
Yu-Cheng Lin ◽  
...  
Keyword(s):  
High Resolution ◽  
Laryngopharyngeal Reflux ◽  
Upper Esophageal Sphincter ◽  
Reflux Symptom ◽  
Clinical Severity ◽  
Reflux Symptom Index ◽  
Esophageal Motility Disorder ◽  
Bolus Transit ◽  
Reflux Symptoms ◽  
Esophageal Sphincter

AbstractLaryngopharyngeal reflux symptom is a troublesome upper esophageal problem, and reflux symptom index (RSI) is commonly applied for the assessment of clinical severity. We investigated the relationship between the upper esophageal sphincter impedance integral (UESII) and RSI scores in this study. Totally 158 subjects with high-resolution esophageal impedance manometry (HRIM) with RSI questionnaire assessment were recruited. There are 57 (36.08%), 74 (46.84%), 21 (13.29%), and 6 (3.79%) patients were categorized as normal, ineffective esophageal motility disorder, absent contractility, and achalasia by HRIM examination, respectively. Subjects with RSI > 13 were noted to have lower UESII than others with RSI ≦ 13 (7363.14 ± 1085.58 vs. 11,833.75 ± 918.77 Ω s cm; P < 0.005). The ROC analysis yielded a UESII cutoff of < 2900 Ω s cm for the best prediction of subjects with RSI > 13 (P = 0.002). Both female gender and UESII cutoff of < 2900 Ω s cm were significant predictors of RSI > 13 in logistic regression analysis (OR = 3.84 and 2.83; P = 0.001 and 0.01; respectively). Lower UESII on HRIM study, indicating poor bolus transit of UES during saline swallows, is significantly associated with prominent laryngopharyngeal reflux symptoms scored by RSI score.

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