title: Pharyngeal function and breathing pattern during partial neuromuscular block in the elderly: effects on airway protection.
abstract: BACKGROUND
  Intact pharyngeal function and coordination of breathing and swallowing are essential for airway protection and to avoid respiratory complications. Postoperative pulmonary complications caused by residual effects of neuromuscular-blocking agents occur more frequently in the elderly. Moreover, elderly have altered pharyngeal function which is associated with increased risk of aspiration. The purpose of this study was to evaluate effects of partial neuromuscular block on pharyngeal function, coordination of breathing and swallowing, and airway protection in individuals older than 65 yr.
  
  
  METHODS
  Pharyngeal function and coordination of breathing and swallowing were assessed by manometry and videoradiography in 17 volunteers, mean age 73.5 yr. After control recordings, rocuronium was administered to obtain steady-state train-of-four ratios of 0.70 and 0.80 followed by spontaneous recovery to greater than 0.90.
  
  
  RESULTS
  Pharyngeal dysfunction increased significantly at train-of-four ratios 0.70 and 0.80 to 67 and 71%, respectively, compared with 37% at control recordings, and swallowing showed a more severe degree of dysfunction during partial neuromuscular block. After recovery to train-of-four ratio of greater than 0.90, pharyngeal dysfunction was not significantly different from the control state. Resting pressure in the upper esophageal sphincter was lower at all levels of partial neuromuscular block compared with control recordings. The authors were unable to demonstrate impaired coordination of breathing and swallowing.
  
  
  CONCLUSIONS
  Partial neuromuscular block in healthy elderly individuals causes an increased incidence of pharyngeal dysfunction from 37 to 71%, with impaired ability to protect the airway; however, the authors were unable to detect an effect of partial neuromuscular block on coordination of breathing and swallowing.
authors.affiliation: 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; the Department of Physiology and Pharmacology (A.I.H.C., E.S., L.I.E.), Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden; and the Department of Diagnostic Radiology (O.E.), Malmö University Hospital, Malmö, Sweden.
authors.forename: Anna I Hårdemark
authors.initials: AI
authors.lastname: Cedborg
authors.forename: Eva
authors.initials: E
authors.lastname: Sundman
authors.forename: Katarina
authors.initials: K
authors.lastname: Bodén
authors.forename: Hanne Witt
authors.initials: HW
authors.lastname: Hedström
authors.forename: Richard
authors.initials: R
authors.lastname: Kuylenstierna
authors.forename: Olle
authors.initials: O
authors.lastname: Ekberg
authors.forename: Lars I
authors.initials: LI
authors.lastname: Eriksson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000399:Air Pressure; D001049:Apnea / Q000503:physiopathology; D016292:Procedural Sedation; D003371:Cough / Q000503:physiopathology; D003679:Deglutition; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D016343:Monitoring, Intraoperative; D019148:Neuromuscular Blockade; D010614:Pharynx / Q000000981:diagnostic imaging / Q000502:physiology*; D011859:Radiography; D015656:Respiratory Mechanics / Q000502:physiology*; D014741:Video Recording