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Randomized Controlled Trial
. 2023 Jan;35(1):e14501.
doi: 10.1111/nmo.14501. Epub 2022 Dec 2.

Effects of dexmedetomidine on pharyngeal swallowing and esophageal motility-A double-blind randomized cross-over study in healthy volunteers

Per Cajander  1 , Taher Omari  2 , Anders Magnuson  3 , Harry Scheinin  4   5 , Mika Scheinin  1 , Johanna Savilampi  1
Affiliations
Randomized Controlled Trial

Effects of dexmedetomidine on pharyngeal swallowing and esophageal motility-A double-blind randomized cross-over study in healthy volunteers

Per Cajander et al. Neurogastroenterol Motil. 2023 Jan.

Abstract

Background: Sedative agents increase the risk of pulmonary aspiration, where an intact swallowing function is an important defense mechanism. Dexmedetomidine is an α2 -adrenoceptor agonist widely used during procedural sedation due to beneficial properties with minimal respiratory effects. The effects of dexmedetomidine on pharyngeal swallowing and esophageal motility are not known in detail.

Methods: To determine the effects of dexmedetomidine on pharyngeal swallowing and esophageal motility, nineteen volunteers were included in this double-blinded, randomized placebo-controlled cross-over study. Study participants received target-controlled dexmedetomidine and placebo infusions. Recordings of pressure and impedance data were acquired using a manometry and impedance solid-state catheter. Data were analyzed from three bolus swallows series: baseline, during dexmedetomidine/placebo infusion at target plasma concentrations 0.6 ng ml-1 and 1.2 ng ml-1 . Subjective swallowing difficulties were also recorded.

Key results: On pharyngeal swallowing, dexmedetomidine affected the upper esophageal sphincter with decreased pre- and post-swallow contractile pressures and an increase in residual pressure during swallow-related relaxation. On esophageal function, dexmedetomidine decreased contractile vigor of the proximal esophagus and increased velocity of the peristaltic contraction wave. Residual pressures during swallow-related esophagogastric junction (EGJ) relaxation decreased, as did basal EGJ resting pressure. The effects on the functional variables were not clearly dose-dependent, but mild subjective swallowing difficulties were more common at the higher dose level.

Conclusions and inferences: Dexmedetomidine induces effects on pharyngeal swallowing and esophageal motility, which should be considered in clinical patient management and also when a sedative agent for procedural sedation or for manometric examination is to be chosen.

Keywords: dexmedetomidine; esophageal motility; pulmonary aspiration; sedatives; swallowing function.

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Figures

FIGURE 1
FIGURE 1
Study outline. 1; insertion of manometry/impedance catheter. T0; first swallow series. 2; Start of study medication (dexmedetomidine/placebo) target concentration 0.6 ng/ml. 3; Target concentration reached. T1; Second swallow series with study drug at 0.6 ng/ml. 4; Increase of target concentration to 1.2 ng/ml. 5; Target concentration reached. T2; Third swallow series with study drug at 1.2 ng/ml. 6; End of experiment. Diamonds with the letter C represent blood sampling for plasma concentration measurements
FIGURE 2
FIGURE 2
The effects of dexmedetomidine on pharyngeal and esophageal variables compared to placebo. Presented as mean line plots with 95% Confidence Interval error bars. BL= without study drug; T1= with study drug at predicted plasma concentration 0.6 ng/ml; T2= with study drug at predicted plasma concentration 1.2 ng/ml. UES BP = UES Pre‐Swallow Basal Pressure, UESCI = Post‐Deglutitive UES Contractile Integral, PCIes= Proximal Esophageal Contractile Integral, DCV = Distal Contractile Velocity, IRP4s = EGJ 4sec Integrated Relaxation Pressure, BPTes = Bolus Presence Time
FIGURE 3
FIGURE 3
Box plot of measured plasma concentrations at predicted target plasma concentration 0.6ng/ml and 1.2 ng/ml
See this image and copyright information in PMC

Comment in

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