- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03283020
Opioid-Induced Swallowing Dysfunction - The Impact of Bolus Volume
Opioid-Induced Swallowing Dysfunction - The Impact of Bolus Volume: a Randomized, Double-Blind Study in Healthy Volunteers
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Monitored anesthesia care (MAC) is commonly applied in modern perioperative care and means that minor surgical procedures are accomplished in awake patients using local anesthesia and light sedation. MAC has many advantages compared to general anesthesia; the recovery time after anesthesia is shorter and risk for postoperative nausea is lower to mention some. However, the patient is spontaneously breathing and the airway is not protected by an endotracheal tube which potentially increases risk of pulmonary aspiration. Pulmonary aspiration, that is inhalation of stomach and/or pharyngeal contents into the lungs, is a severe anesthesia-related complication and can in worst case lead to pneumonia and even death. Intact swallowing function is crucial in avoiding aspiration and how sedatives and analgesic agents used during MAC influence swallowing function is not fully understood.
Pharyngeal function during bolus swallowing is measured by combined high resolution impedance manometry (HRIM). The HRIM catheter is inserted through the nose in such a way that sensors straddle the entire pharynx and esophagus with the distal catheter tip in the stomach. Dynamic pressure changes and flow can be detected during swallowing and data registered by HRIM are analysed using purpose-designed software, AIM analysis (automated impedance manometry analysis). AIM analysis derives pressure flow variables which describe different physiological events like bolus timing and bolus distension in the pharynx and the esophagus during swallowing. A Swallow Risk Index value, quantifying risk of deglutitive aspiration, can also be defined.
The aim of the study is to evaluate impact of different bolus volumes on remifentanil-induced swallowing dysfunction in healthy volunteers. The study will clarify underlying mechanisms (central vs. peripheral effects) of remifentanil-induced swallowing dysfunction. Furthermore, whether swallowing tasks can be done safer during sedation by altering bolus volumes will be revealed. In addition to bolus volume, different bolus viscosities will be tested. It is shown that higher bolus viscosity diminishes misdirected swallows in dysphagic patients and higher bolus viscosity may possibly counteracts the swallowing dysfunction induced by remifentanil. Moreover, if MNTX reverses the remifentanil-induced effects on swallowing, then this would suggest a dominant peripherally mediated mechanism. Our aim is also to evaluate impact of remifentanil exposure on esophageal motility and impact of methylnaltrexone alone on swallowing function.
20 healthy volunteers will be studied on two different occasions approximately one week apart. In a randomized order volunteers will receive intravenous infusion of remifentanil and an intravenous injection of MNTX on one occasion, and placebo (normal saline) infusion and an intravenous injection of MNTX on the other occasion. Blood samples are obtained for plasma concentration determination of the study drug and sedation levels are assessed during study drug exposure.
Study Type
Enrollment (Anticipated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Johanna Savilampi, MD, PhD
- Phone Number: +46196020266
- Email: johanna.savilampi@regionorebrolan.se
Study Locations
-
-
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Örebro, Sweden, 70185
- Recruiting
- Department of Anaesthesiology and Intensive Care, Örebro University Hospital
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Contact:
- Johanna Savilampi, Phd
- Email: johanna.savilampi@regionorebrolan.se
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Contact:
- Per Cajander, MD
- Email: per.cajander@regionorebrolan.se
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- ≥ 18 - ≤ 40 year old healthy volunteers from both sexes.
- Have signed and dated Informed Consent.
- Willing and able to comply with the protocol for the duration of the trial.
Exclusion Criteria:
- Anamnesis of pharyngoesophageal dysfunction.
- Known or history of gastrointestinal, severe cardiac, pulmonary or neurological disease
- Ongoing medication that may affect upper gastrointestinal tract, larynx or lower airway.
- Allergies to or history of reaction to remifentanil, fentanyl analogues or dexmedetomidine.
- Pregnancy or breast feeding
- BMI > 30
- Smoking
- Previous participation in a medicinal clinical trial during the last year where an opioid has been used or have during the last 30 days participated in any other medicinal clinical trial or in a trial where follow-up is not completed.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Basic Science
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: RemifentanilMNTX
Volunteers are given an intravenous infusion with remifentanil, with an effect-site target concentration of 3 ng/ml via a target-controlled infusion (TCI) pump.
After a series of swallowing tests an intravenous injection of methylnaltrexone of 0,3 mg/kg is given.
|
Remifentanil infusion TCI 3 ng/ml, Methylnaltrexone injection 0.3 mg/kg
Other Names:
|
Active Comparator: PlaceboMNTX
Volunteers are given an intravenous infusion with saline 0,9%.
After a series of swallowing tests an intravenous injection of methylnaltrexone of 0,3 mg/kg is given.
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Placebo (NaCl 0.9%) TCI infusion, Methylnaltrexone injection 0.3 mg/kg
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Pressure Flow pharyngeal variables, 10 ml vs 20 ml bolus
Time Frame: Up to 60 minutes
|
Difference in pharyngeal pressure flow variables during remifentanil exposure between bolus volumes of 10 ml and 20 ml compared to placebo.
|
Up to 60 minutes
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Pressure Flow pharyngeal variables, liquid vs semisolid bolus
Time Frame: Up to 60 minutes
|
Difference in pharyngeal pressure flow variables during remifentanil exposure between liquid and semisolid boluses compared to placebo
|
Up to 60 minutes
|
Pressure Flow pharyngeal variables, remifentanil before vs after methylnaltrexone
Time Frame: Up to 60 minutes
|
Difference in pharyngeal pressure flow variables during remifentanil exposure before and after methylnaltrexone administration compared to placebo.
|
Up to 60 minutes
|
Pressure Flow pharyngeal variables, placebo before vs after methylnaltrexone
Time Frame: Up to 60 minutes
|
Difference in pharyngeal pressure flow variables during placebo infusion before and after methylnaltrexone administration.
|
Up to 60 minutes
|
Pressure Flow esophageal motility variables, 10 ml vs 20 ml bolus
Time Frame: Up to 60 minutes
|
Difference in variables of esophageal motility between different bolus volumes during remifentanil exposure compared to placebo.
|
Up to 60 minutes
|
Pressure Flow esophageal motility variables, liquid vs semisolid bolus
Time Frame: Up to 60 minutes
|
Difference in variables of esophageal motility between liquid and semisolid boluses during remifentanil exposure compared to placebo.
|
Up to 60 minutes
|
Pressure Flow esophageal motility variables, remifentanil before vs after methylnaltrexone
Time Frame: Up to 60 minutes
|
Difference in variables of esophageal motility during remifentanil exposure before and after methylnaltrexone administration compared to placebo.
|
Up to 60 minutes
|
Pressure Flow esophageal motility variables, placebo before vs after methylnaltrexone
Time Frame: Up to 60 minutes
|
Difference in variables of esophageal motility during placebo infusion before and after methylnaltrexone administration.
|
Up to 60 minutes
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Johanna Savilampi, MD, PhD, University Hospital in Örebro
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- JS006
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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