title: Swallowing Impairment During Propofol Target-Controlled Infusion.
abstract: BACKGROUND
  Sedatives can impair the swallowing process. We assessed the incidence and severity of swallowing impairment in patients sedated with propofol at clinically relevant doses. We also identified factors that were predictive of swallowing impairment.
  
  
  METHODS
  In 80 patients scheduled to undergo elective gastrointestinal endoscopy under target-controlled infusion (TCI) propofol sedation, swallowing was evaluated by glottis videoendoscopy, using the Dysphagia Severity Score (DSS) and the Penetration and Aspiration Scale (PAS). The level of sedation was assessed with the Observer's Assessment of Alertness/Sedation (OAAS) scale. Evaluations were obtained within each patient at 3 target effect-site propofol concentrations of 2, 3, and 4 μg/mL (Marsh model).
  
  
  RESULTS
  At 2 μg/mL TCI, the OAAS score was 2 in 21 (26.25%) patients and 1 in 59 (73.75%). The OAAS score was 1 in all patients at 3 and 4 μg/mL TCI target. At 3 μg/mL TCI target, 19 (24.36%) patients had a DSS = 3 and 18 patients (23.08%) had a PAS = 7-8 (severe swallowing impairment). DSS was associated with increasing age (5-year odds ratio [OR] 1.53 [1.22-1.93]; P < 0.001), body mass index (BMI; OR 1.24 [1.08-1.42]; P = 0.002), and TCI target (OR 15.80 [7.76-32.20]; P < 0.001). In an alternative model incorporating OAAS instead of TCI target, DSS was associated with increasing age (5-year OR 1.13 [1.02-1.24]; P = 0.014) and BMI (OR 1.08 [1.02-1.15]; P = 0.006) and decreasing OAAS (OR 0.05 [0.006-0.36]; P = 0.003). PAS was associated with increasing age (5-year OR 1.09 [1.04-1.15]; P < 0.001), BMI (OR 1.23 [1.07-1.41]; P = 0.003), and TCI target (OR 15.23 [7.45-31.16]; P < 0.001). In an alternative model incorporating OAAS instead of TCI target, PAS was associated with increasing age (5-year OR 1.14 [1.04-1.26]; P = 0.007) and BMI (OR 1.09 [1.02-1.15]; P = 0.006) and decreasing OAAS (OR 0.05 [0.006-0.41]; P = 0.005).
  
  
  CONCLUSIONS
  Aspiration due to swallowing impairment may occur during deep sedation produced by propofol at commonly used TCI targets. TCI targets are predictors of swallowing impairment; increased age and high BMI are concomitant risk factors.
authors.affiliation: From the *Head and Neck Department-Anesthesia and Neurosurgical Intensive Care Unit, IRCCS Ospedale San Raffaele, Milan, Italy; †Department of Anesthesia and Intensive Care, IRCCS Ospedale San Raffaele, Milan, Italy; and ‡Otolaryngology Department, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Gemma
authors.forename: Laura
authors.initials: L
authors.lastname: Pasin
authors.forename: Alessandro
authors.initials: A
authors.lastname: Oriani
authors.forename: Massimo
authors.initials: M
authors.lastname: Agostoni
authors.forename: Francesca
authors.initials: F
authors.lastname: Palonta
authors.forename: Barbara
authors.initials: B
authors.lastname: Ramella
authors.forename: Mario
authors.initials: M
authors.lastname: Bussi
authors.forename: Luigi
authors.initials: L
authors.lastname: Beretta
mesh_terms: D000367:Age Factors; D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D015992:Body Mass Index; D003243:Consciousness / Q000187:drug effects; D054810:Deep Sedation / Q000009:adverse effects*; D003679:Deglutition / Q000187:drug effects*; D003680:Deglutition Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D016099:Endoscopy, Gastrointestinal; D004947:Esophagus / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D063466:Respiratory Aspiration of Gastric Contents / Q000209:etiology; D012307:Risk Factors; D012720:Severity of Illness Index; D014741:Video Recording
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol