Related Experiment Video
Updated: Jan 8, 2026
Minimally Invasive Murine Laryngoscopy for Close-Up Imaging of Laryngeal Motion During Breathing and Swallowing
Published on: December 1, 2023
Sevoflurane Dose and Timing Affects Esophageal Contractility During Functional Lumen Imaging Probe
Erin E Toaz1, Alain J Benitez2, Eric C Cheon1
1Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Insights
Anesthesia with sevoflurane significantly impacts esophageal contractile response (CR) in children undergoing functional lumen imaging probe (FLIP) testing. Higher sevoflurane doses and specific timing are linked to abnormal CR, affecting dysphagia evaluations.
Area of Science:
- Pediatric Gastroenterology
- Anesthesiology
- Esophageal Physiology
Background:
- Functional lumen imaging probe (FLIP) assesses esophageal contractile response (CR).
- Anesthetic agents can alter esophageal contractility during endoscopy.
- The specific effects of anesthetics on pediatric esophageal CR are not well understood.
Purpose of the Study:
- To investigate the association between anesthetic administration and esophageal CR in pediatric patients undergoing FLIP.
- To determine if sevoflurane dose and timing affect esophageal CR during FLIP procedures.
Main Methods:
- Retrospective review of pediatric patients (3-22 years) undergoing FLIP for dysphagia.
- Analysis of anesthetic dose, timing, and FLIP-derived CR.
- Logistic regression to assess the impact of sevoflurane on absent CR; comparison of end-tidal sevoflurane concentrations.
Main Results:
- 80% of 303 pediatric patients had abnormal esophageal CR.
- Sevoflurane administration was associated with an 8.4-fold increased odds of absent CR (P < 0.001).
- Higher sevoflurane use and end-tidal concentrations were observed in patients with abnormal CR.
Conclusions:
- Anesthetic timing and sevoflurane dosage are strongly associated with impaired esophageal CR during FLIP in children.
- Findings highlight the need to consider anesthetic effects when interpreting FLIP results in pediatric dysphagia evaluations.
Introduction:
Functional lumen imaging probe (FLIP) can assess the esophageal contractile response (CR). Anesthetic agents used during endoscopy affect esophageal contractility, however, the time or dose-dependent effect of specific medications on the esophageal CR in children is unknown.
Methods:
Charts of patients aged 3-22 years undergoing endoscopy with FLIP for evaluation of dysphagia at 2 tertiary pediatric hospitals were reviewed. Anesthetic dose and timing were collected. FLIP data were exported to Wklytics to generate Panometry plots, and the CR was classified as normal, borderline, spastic, impaired, or absent based on established definitions. Binary logistic regression was performed to assess whether anesthetic administration was associated with absent CR. End-tidal sevoflurane concentration was compared across groups with normal, borderline, and absent/impaired CR.
Results:
Three hundred-three pediatric patients with a mean (SD) age of 13 years (4), 65% adolescent boys, were included. Totally, 80 (26%) had abnormal esophageal CR, where 16 (5%) were impaired, 63 (21%) were absent, and 1 was spastic. Two hundred twenty-eight (75%) were diagnosed with eosinophilic esophagitis, and 215 (71%) received sevoflurane. The odds ratio for absent CR if sevoflurane was administered was 8.4 ( P < 0.001). Sevoflurane was used significantly more often for both induction and maintenance in patients with abnormal CR compared with normal CR (70% vs 38%, P < 0.001). During the maintenance phase of anesthesia, end-tidal sevoflurane concentration was higher in patients with abnormal CR compared with normal CR independent of propofol infusion, recruitment site, and distensibility.
Discussion:
The timing and dose of sevoflurane is strongly associated with esophageal CR impairment during FLIP.
