Valuation of Swallowing in Patient Sedated for Gastroenteric Endoscopic Procedure

All patients will be sedated using propofol target controlled infusion (TCI) with a target of 2-5 mcg/ml During sedation and examination will be monitored: cardiac frequency, peripheral oxygen saturation and non-invasive arterial blood pressure.

During sedation, before starting the gastroenteric endoscopic exam, will be performed a fibroscopic swallowing evaluation made by an expert otolaryngologist.

Fibroscopic evaluation consist of:

• laryngeal fibroscopy to evaluate vocal cord motility
• swallowing trial using 3 blue colored water bolus (3-4ml) and computing a " Penetration-aspiration scale" and an " Aspiration risk scale"

Rosenbek, Robbins et al. A Penetration-Aspiration Scale. Dysphagia 11:93-98, 1996:

• No penetration in the airway
• Bolus reaches the airway, it does not reach vocal cords and it is completely eliminated
• Bolus reaches the airway, it does not reach vocal cords but it is not completely eliminated
• Bolus reaches the airway, it reaches vocal cords but it is completely eliminated
• Bolus reaches the airway, it reaches vocal cords and it is not completely eliminated
• Bolus reaches the airway, it passes trough vocal cords but it is completely eliminated
• Bolus reaches the airway, it passes trough vocal cords, it is not eliminated but patient strives to expel it
• Bolus reaches the airway, it passes trough vocal cords, it is not eliminated and patient does not strive to expel it

Daniels e coll.: Clinical Predictors of Dysphagia and Aspiration Risk: Outcome Measures in Acute Stroke Patients. Arch Phys Med Rehab Vol 81, August 2000:

• Normal swallowing : no aspiration or penetration in the airway
• Trivial swallowing impairment: oral or pharyngeal impairment that causes occasional airway penetration with rapid clearance
• Moderate swallowing impairment: oral or pharyngeal impairment that causes consistent airway penetration with stasis into the vestibule or two or less event of aspiration of a similar viscosity aliment
• Moderate-severe swallowing impairment: oral or pharyngeal impairment that causes an important aspiration of a similar viscosity aliment
• Severe swallowing impairment: oral or pharyngeal impairment that causes an important aspiration of similar or different viscosity

Inclusion criteria

• American Society of Anesthesiologists (ASA) physical status I-II-III
• Able to give written consent with none exclusion criteria.

Exclusion criteria

• presence of feeding tube
• presence of tracheostomy actual or in the past
• severe respiratory deficit
• neurological disease which can compromise swallowing function
• history of surgery for mouth or pharyngeal or esophageal cancer
• history of otolaryngology surgery
• faring-laryngeal radiotherapy
• emergent procedure
• psychic alteration
• patient in therapy with any kind of antidepressant drugs
• insulin dependent diabetes mellitus patient