I would like to describe for JCDA readers a technique that we have found to be useful in administering perioperative capsules and pills for all patients. It is especially valuable for the 40% of adults who have difficulty swallowing.1
When patients swallow in an upright position, the tongue and pharyngeal musculature move the bolus horizontally towards the esophageal area. It is in these preparatory phases of swallowing under voluntary neuromuscular control that swallowing difficulties arise with many patients. Once in the esophageal area, an automatic peristaltic movement transports the bolus into the stomach.
The difficulties that many patients have when swallowing capsules and tablets can be controlled by positioning patients in a supine position. This allows the preparatory voluntary phases of swallowing to follow a vertical path, allowing gravity to do most of the work.
The technique consists of a brief instruction phase when patients are trained to swallow water at body temperature as it is poured slowly into their mouth while in the usual supine position used for most dental procedures (Fig. 1).
Once they are comfortable with this unfamiliar procedure, the medication is administered (Fig. 2). We consistently get good results using this method.
I plan to investigate this concept in a formal study and submit the results for publication. Colleagues interested in participating in this study can contact me at: firstname.lastname@example.org.
- DeRoche C, Macclaren G, Sonies B. Pill swallowing problems in America: a national survey of adults. New York: Harris Interactive Inc.; 2003.