title: Effects of morphine and midazolam on pharyngeal function, airway protection, and coordination of breathing and swallowing in healthy adults.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors: 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.).
authors: Anna I
authors: AI
authors: Hårdemark Cedborg
authors: Eva
authors: E
authors: Sundman
authors: Katarina
authors: K
authors: Bodén
authors: Hanne Witt
authors: HW
authors: Hedström
authors: Richard
authors: R
authors: Kuylenstierna
authors: Olle
authors: O
authors: Ekberg
authors: Lars I
authors: LI
authors: Eriksson
mesh_terms: D000328:Adult; D058109:Airway Management / Q000379:methods*; D000701:Analgesics, Opioid / Q000097:blood / Q000494:pharmacology*; D001696:Biomechanical Phenomena; D016292:Procedural Sedation; D003679:Deglutition / Q000187:drug effects*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D008297:Male; D008874:Midazolam / Q000494:pharmacology*; D009020:Morphine / Q000097:blood / Q000494:pharmacology*; D010614:Pharynx / Q000000981:diagnostic imaging / Q000187:drug effects*; D012123:Pulmonary Ventilation; D011859:Radiography; D012119:Respiration / Q000187:drug effects*; D014741:Video Recording; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D009020:Morphine; D008874:Midazolam