Free
Correspondence  |   February 2015
In Reply
Author Notes
  • Örebro University Hospital, Örebro, Sweden, and Örebro University, Örebro, Sweden (J.S.). johanna.savilampi@orebroll.se
  • Accepted for publication October 24, 2014.
    Accepted for publication October 24, 2014.×
Article Information
Correspondence
Correspondence   |   February 2015
In Reply
Anesthesiology 2 2015, Vol.122, 472. doi:10.1097/ALN.0000000000000536
Anesthesiology 2 2015, Vol.122, 472. doi:10.1097/ALN.0000000000000536
In Reply:
We would like to thank Dr. J. Kyle Bohman for his interest in our article1  and his comments concerning the underlying mechanisms of pulmonary aspiration induced by remifentanil. We fully agree that our study did not reveal whether the radionuclide solution detected in lung fields was directly aspirated from the pharynx, or if it was first swallowed then regurgitated and aspirated. However, we state that even though only pharyngeal-to-pulmonary aspiration would have occurred in our investigation, the findings are important to take into account when using remifentanil for compromised patients with increased risk of reflux by other pathways. The possible risks associated with remifentanil attracted our attention, when in our previous research2,3  volunteers spontaneously reported swallowing difficulty when receiving the drug; the purpose of our current study thus was to determine whether remifentanil increases the risk for aspiration. Additional investigations are needed to more closely examine which level of defense against pulmonary aspiration is affected. It should be feasible, although logistically difficult, to achieve the dynamic collection of a series of lung scans by having the subject lie in the gamma camera during the entire study session. In this way, the whole pattern could be visualized as a film and show the route of the radionuclide solution.
Competing Interests
The authors declare no competing interests.
Johanna Savilampi, M.D., Rebecca Ahlstrand, M.D.,
Ph.D., Håkan Geijer, M.D., Ph.D., Magnus Wattwil,
M.D., Ph.D. Örebro University Hospital, Örebro, Sweden,
and Örebro University, Örebro, Sweden (J.S.).
johanna.savilampi@orebroll.se
References
Savilampi, J, Ahlstrand, R, Magnuson, A, Geijer, H, Wattwil, M Aspiration induced by remifentanil: A double-blind, randomized, crossover study in healthy volunteers.. Anesthesiology. (2014). 121 52–8 [Article] [PubMed]
Thorn, K, Thorn, SE, Wattwil, M The effects of cricoid pressure, remifentanil, and propofol on esophageal motility and the lower esophageal sphincter.. Anesth Analg. (2005). 100 1200–3 [Article] [PubMed]
Walldén, J, Thörn, SE, Wattwil, M The delay of gastric emptying induced by remifentanil is not influenced by posture.. Anesth Analg. (2004). 99 429–34 [Article] [PubMed]