The questionable efficacy of topical pharyngeal anesthesia in combination with propofol sedation in gastroscopy

Hsin I. Tsai, Yung Fung Tsai, Shiue Chin Liou, Ming Yao Su, Chih Chung Lin, Chee Jen Chang, Huang Ping Yu*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

11 Scopus citations

Abstract

Background Topical pharyngeal anesthesia as an adjunct to intravenous sedation to facilitate gastroscopy has been widely acknowledged; however, its efficacy has not been established when it is used in patients under deep sedation with propofol. Aims To demonstrate the limited value of topical pharyngeal anesthesia in patients under moderate to deep sedation with propofol. Methods One hundred and twenty-nine patients undergoing gastroscopy were prospectively randomized to receive 10 % lidocaine or distilled water topical spray as an adjunct to intravenous propofol via target-controlled infusion. Verbal and somatic responsiveness, presence of gag reflex and hiccup to esophageal intubation, and the overall ease of the procedure were evaluated by the anaesthetists and gastroenterologists. Hemodynamic parameters including peripheral oxygen saturation, systolic/diastolic blood pressure (SBP/DBP), heart rate (HR), bispectral index, and SBP 9 HR were compared at 5 time points: on arrival, after 5 spontaneous breaths, when estimated brain concentration of propofol, Ce, reached 3.5 lg/ml, on esophageal intubation, and on awakening. Results No statistical difference was observed between the lidocaine and distilled water group in verbal or somatic responses, gag reflex or hiccups on esophageal intubation. Similarly, BIS, SBP, DBP, and HR showed no significant difference between the groups. Conclusions The use of topical pharyngeal anesthesia in combination with target-controlled infusion with propofol in the performance of diagnostic gastroscopy might be eliminated without adversely affecting patient care or outcomes.

Original languageEnglish
Pages (from-to)2519-2526
Number of pages8
JournalDigestive Diseases and Sciences
Volume57
Issue number10
DOIs
StatePublished - 10 2012

Keywords

  • Bispectral index
  • Deep sedation
  • Endoscopy
  • Propofol
  • Target controlled infusion
  • Topical pharyngeal anesthesia

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