Anesthesiology 2015 Jun;122(6):1253-67
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; Diagnostic Radiology, Malmö University Hospital, Malmö, Sweden (O.E.); and Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden (A.I.H.C., E.S., K.B., H.W.H., R.K., L.I.E.).
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.