Swallowing Impairment During Propofol Target-Controlled Infusion

Area of Science:

• Anesthesiology
• Gastroenterology
• Swallowing Disorders

Background:

• Sedative medications, such as propofol, can negatively impact the physiological process of swallowing.
• Assessing the incidence and severity of dysphagia in patients receiving propofol sedation is crucial for patient safety.
• Identifying factors that predict swallowing impairment during sedation can inform clinical practice and risk mitigation strategies.

Purpose of the Study:

• To evaluate the occurrence and degree of swallowing impairment in patients sedated with propofol at clinically relevant doses.
• To determine the relationship between propofol target-controlled infusion (TCI) concentrations and swallowing function.
• To identify patient-specific factors (e.g., age, BMI, sedation level) that predict swallowing impairment.

Main Methods:

• Eighty patients undergoing elective gastrointestinal endoscopy were enrolled.
• Propofol sedation was administered using target-controlled infusion (TCI) at effect-site concentrations of 2, 3, and 4 μg/mL (Marsh model).
• Swallowing function was assessed using glottis videoendoscopy, the Dysphagia Severity Score (DSS), and the Penetration and Aspiration Scale (PAS). Sedation levels were monitored with the Observer's Assessment of Alertness/Sedation (OAAS) scale.

Main Results:

• At 3 μg/mL TCI propofol, significant swallowing impairment was observed (DSS=3 in 24.36%, PAS=7-8 in 23.08%).
• Swallowing impairment (DSS and PAS scores) was significantly associated with higher TCI targets, increasing age, and higher body mass index (BMI).
• Lower levels of sedation (higher OAAS scores) correlated with better swallowing function, independent of TCI target.

Conclusions:

• Deep sedation with propofol at common TCI targets can lead to dysphagia and increase aspiration risk.
• Propofol TCI targets are significant predictors of swallowing impairment.
• Advanced age and elevated BMI are identified as independent risk factors for propofol-induced swallowing difficulties.