title: Tactile stimulation of the oropharynx elicits sympathoexcitation in conscious humans.
abstract: Tactile stimulation of the oropharynx (TSO) elicits the gag reflex and increases heart rate (HR) and mean arterial pressure (MAP) in anesthetized patients. However, the interaction between upper-airway defense reflexes and the sympathetic nervous system has not been investigated in conscious humans. In Experiment 1, beat-by-beat measurements of HR, MAP, muscle sympathetic nerve activity (MSNA), and renal vascular resistance (RVR) were measured during TSO and tactile stimulation of the hard palate (Sham) in the supine posture. In Experiment 2, TSO was performed before (pre) and after (post) inhalation of 4% lidocaine via nebulizer. Rate pressure product (RPP) was determined. Compared with Sham, TSO elicited the gag reflex and increased RPP [absolute change (Δ)36 ± 6 vs. 17 ± 5%], MSNA (Δ122 ± 39 vs. 19 ± 19%), and RVR (Δ55 ± 11 vs. 4 ± 4%). This effect occurred within one to two cardiac cycles of TSO. The ΔMAP (12 ± 3 vs. 6 ± 1 mmHg) and the ΔHR (10 ± 3 vs. 3 ± 3 beats/min) were also greater following TSO compared with Sham. Lidocaine inhalation blocked the gag reflex and attenuated increases in MAP (Δpre: 16 ± 2; Δpost: 5 ± 2 mmHg) and HR (Δpre: 12 ± 3; Δpost: 2 ± 2 beats/min) in response to TSO. When mechanically stimulated, afferents in the oropharynx not only serve to protect the airway but also cause reflex increases in MSNA, RVR, MAP, and HR. An augmented sympathoexcitatory response during intubation and laryngoscopy may contribute to perioperative cardiovascular morbidity and mortality.
authors.affiliation: Penn State Hershey Heart and Vascular Institute, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Muller
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Mast
authors.forename: Jian
authors.initials: J
authors.lastname: Cui
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Heffernan
authors.forename: Patrick M
authors.initials: PM
authors.lastname: McQuillan
authors.forename: Lawrence I
authors.initials: LI
authors.lastname: Sinoway
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000494:pharmacology; D062186:Arterial Pressure; D001794:Blood Pressure / Q000502:physiology; D003080:Cold Temperature; D003627:Data Interpretation, Statistical; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D008012:Lidocaine / Q000494:pharmacology; D008297:Male; D009960:Oropharynx / Q000187:drug effects / Q000294:innervation* / Q000502:physiology*; D021362:Palate, Hard / Q000502:physiology; D010812:Physical Stimulation; D011312:Pressure; D012018:Reflex / Q000187:drug effects / Q000502:physiology; D012079:Renal Circulation / Q000502:physiology; D013564:Sympathetic Nervous System / Q000187:drug effects / Q000502:physiology*; D013610:Tachycardia / Q000503:physiopathology; D014655:Vascular Resistance / Q000502:physiology; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine
keywords: afferent; blood flow; local anesthesia; pharynx; sympathetic nervous system