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Topical Pharyngeal Lidocaine Reduces Respiratory Adverse Events During Upper Gastrointestinal Endoscopies Under Ketamine Sedation in Children

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Abstract

Background

Upper gastrointestinal endoscopies (UGEs) performed under ketamine sedation may increase the risk of respiratory adverse events (RAEs) due to pharyngeal stimulation. Topical lidocaine prevents general anesthesia-induced laryngospasm.

Objective

Our objective was to determine whether topical lidocaine may reduce the incidence of RAEs induced by pharyngeal stimulation in UGEs performed on children sedated with ketamine.

Methods

We conducted a single-center prospective study. We included every patient admitted for an elective diagnostic UGE under ketamine sedation who received lidocaine prior to the technique. Patients requiring any other medication were excluded. Our main outcome measure was the number of desaturation episodes. We then compared these results with those obtained in an historic group who did not receive topical lidocaine, in which we registered a total of 54 desaturation episodes.

Results

In total, 88 children (52.3% boys) were included. The median age was 7 years [interquartile range (IQR) 3–11]. The mean duration of the procedure was 6.5 ± 2.4 min, and the median initial ketamine dose was 1.76 mg/kg (IQR 1.56–2.03). The total number of desaturation episodes was 3 (3.4%), and two of these occurred prior to the introduction of the endoscope. This result represents a lower incidence than in previously reported series, and a significant decrease (p < 0.0001) with respect to the 54 RAEs registered in the historic group of 87 children.

Conclusions

Topical lidocaine premedication significantly reduced the incidence of RAEs in children during UGEs under ketamine sedation. Our findings should be confirmed by a double-blind randomized controlled trial.

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Authors and Affiliations

  1. Pediatric Intensive Care Unit, Puerta del Mar University Hospital, Avda Ana de Viya 21, 11009, Cádiz, Spain

    Jose Carlos Flores-González, Ana Estalella-Mendoza & Patricia Rodríguez-Campoy

  2. Clinical Farmacology Unit, Puerta del Mar University Hospital, Cadiz, Spain

    Mónica Saldaña-Valderas

  3. Mother and Child Health, and Radiology Department, Cádiz University, Cadiz, Spain

    Alfonso M. Lechuga-Sancho

  4. Institute of Research and Innovation in Biomedical Sciences (INIBiCA), Cadiz, Spain

    Jose Carlos Flores-González, Ana Estalella-Mendoza, Patricia Rodríguez-Campoy, Mónica Saldaña-Valderas & Alfonso M. Lechuga-Sancho

Authors
  1. Jose Carlos Flores-González
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  2. Ana Estalella-Mendoza
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  3. Patricia Rodríguez-Campoy
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  4. Mónica Saldaña-Valderas
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  5. Alfonso M. Lechuga-Sancho
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Corresponding author

Correspondence to Jose Carlos Flores-González.

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Conflict of Interest

JCFG, AEM, PRC, MSV, and AMLS have no conflicts of interest that are directly relevant to the content of this article.

Funding

No sources of funding were used to conduct this study or prepare this manuscript.

Ethical approval and informed consent

The study was approved by the appropriate institutional review board (Research Committee of Cádiz), and written informed consent was obtained from all subjects, a legal surrogate, or the parents or legal guardians for minor subjects.

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Flores-González, J.C., Estalella-Mendoza, A., Rodríguez-Campoy, P. et al. Topical Pharyngeal Lidocaine Reduces Respiratory Adverse Events During Upper Gastrointestinal Endoscopies Under Ketamine Sedation in Children. Pediatr Drugs 21, 25–31 (2019). https://doi.org/10.1007/s40272-018-0320-2

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  • DOI: https://doi.org/10.1007/s40272-018-0320-2

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