Swallowing Impairment During Propofol Target-Controlled Infusion

Gemma, Marco MD*; Pasin, Laura MD; Oriani, Alessandro MD*; Agostoni, Massimo MD*; Palonta, Francesca MD; Ramella, Barbara BA; Bussi, Mario MD; Beretta, Luigi MD*

doi: 10.1213/ANE.0000000000000796
Ambulatory Anesthesiology and Perioperative Management: Research Report

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.

Published ahead of print June 3, 2015

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.

Accepted for publication January 29, 2015.

Published ahead of print June 3, 2015

Funding: None.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Oriani Alessandro, MD, Head and Neck Department-Anesthesia and Neurosurgical Intensive Care Unit, IRCCS Ospedale San Raffaele, via Olgettina, 60 Milan, Italy. Address e-mail to alex. oriani@gmail.com.

© 2016 International Anesthesia Research Society