Detecting Oropharyngeal and Esophageal Emptying by Submental Ultrasonography and High-Resolution Impedance Manometry: Intubated vs. Non-Intubated Video-Assisted Thoracoscopic Surgery.

Chih-Jun Lai,Jin-Shing Chen,Yi-Ju Huang,Shih-I Ho,Zhi-Yin Lu,Ya-Jung Cheng

doi:10.3390/diagnostics10121079

Chih-Jun Lai, Jin-Shing Chen + Show 4 more

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https://doi.org/10.3390/diagnostics10121079

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Abstract

Postoperative swallowing, affected by general anesthesia and intubation, plays an important part in airway and oral intake safety regarding effective oropharyngeal and esophageal emptying. However, objective evidence is limited. This study aimed to determine the time required from emergence to effective oropharyngeal and esophageal emptying in patients undergoing non-intubated (N) or tracheal-intubated (I) video-assisted thoracoscopic surgery (VATS). Hyoid bone displacement (HBD) by submental ultrasonography and high-resolution impedance manometry (HRIM) measurements were used to assess oropharyngeal and esophageal emptying. HRIM was performed every 10 min after emergence, up to 10 times. The primary outcome was to determine whether intubation affects the time required from effective oropharyngeal to esophageal emptying. The secondary outcome was to verify if HBD is comparable to preoperative data indicating effective oropharyngeal emptying. Thirty-two patients suitable for non-intubated VATS were recruited. Our results showed that comparable HBDs were achieved in all patients after emergence. Effective esophageal emptying was achieved at the first HRIM measurement in 11 N group patients and 2 I group patients (p = 0.002) and was achieved in all N (100%) and 13 I group patients (81%) within 100 min (p = 0.23). HBD and HRIM are warranted for detecting postoperative oropharyngeal and esophageal emptying.

Highlights

Successful postoperative swallowing includes efficient oropharyngeal and esophageal emptying [1]
We aimed to determine the time required to regain successful oropharyngeal and esophageal emptying through submental ultrasonography and high-resolution impedance manometry (HRIM) for non-intubated (N) or tracheal-intubated (I) patients after video-assisted thoracoscopic surgery (VATS)
We demonstrated that relative to other measurement techniques, HRIM is a powerful tool for assessing esophageal emptying, with acceptable levels of discomfort caused by the retained catheter in the throat

Summary

Introduction

Successful postoperative swallowing includes efficient oropharyngeal and esophageal emptying [1]. Efficient oropharyngeal emptying is crucial for postoperative airway safety. With adequate muscle power to propel the bolus from the oropharynx into the upper esophageal sphincter (UES) [2], oropharyngeal emptying keeps the airway clear, preventing choking and aspiration in advance of inducing the cough reflex. Efficient esophageal peristalsis and emptying, i.e., propelling the bolus through the esophagus and lower esophageal sphincter into the stomach [3], are essential for smooth postoperative oral intake. The possibility of postoperative regurgitation and even aspiration risk may increase until effective esophageal peristalsis and emptying functions are regained [4]. The effects of intubation during operations and anesthesia on oropharyngeal and esophageal emptying have seldom been investigated. Most previous studies have focused on the effects of prolonged intubation (>48 h) through questionnaires or flexible endoscopic evaluation of swallowing [6,7,8,9,10]

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