Valuation of Swallowing in Patient Sedated for Gastroenteric Endoscopic Procedure
Condition: Sedation for Gastroenteric Endoscopic Procedure; Deglutition Disorders; Aspiration of Food
MeSH terms: Deglutition Disorders
Study type: Observational

Summary: 
      Aim of this study is to evaluate swallowing functionality in patient sedated for
      gastroenteric endoscopic procedure.

      Swallowing will be study by laryngeal fibroscopy and evaluate using Penetration-Aspiration
      Scale and Aspiration Risk validated in scientific literature.

      Aim of the study is to describe swallowing, as an expression of airway protection, in sedated
      patient. in particular, our purpose is to determine the incidence of moderate-severe and
      severe swallowing alteration (level 3 or 4 of Aspiration Risk scale).
    

Detailed description: 
      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:

        1. No penetration in the airway

        2. Bolus reaches the airway, it does not reach vocal cords and it is completely eliminated

        3. Bolus reaches the airway, it does not reach vocal cords but it is not completely
           eliminated

        4. Bolus reaches the airway, it reaches vocal cords but it is completely eliminated

        5. Bolus reaches the airway, it reaches vocal cords and it is not completely eliminated

        6. Bolus reaches the airway, it passes trough vocal cords but it is completely eliminated

        7. Bolus reaches the airway, it passes trough vocal cords, it is not eliminated but patient
           strives to expel it

        8. 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:

        1. Normal swallowing : no aspiration or penetration in the airway

        2. Trivial swallowing impairment: oral or pharyngeal impairment that causes occasional
           airway penetration with rapid clearance

        3. 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

        4. Moderate-severe swallowing impairment: oral or pharyngeal impairment that causes an
           important aspiration of a similar viscosity aliment

        5. Severe swallowing impairment: oral or pharyngeal impairment that causes an important
           aspiration of similar or different viscosity
    

Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patient sedated for gastroenteric endoscopic examination