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

  • Jose Carlos Flores-GonzálezEmail author
  • Ana Estalella-Mendoza
  • Patricia Rodríguez-Campoy
  • Mónica Saldaña-Valderas
  • Alfonso M. Lechuga-Sancho
Short Communication
  • 29 Downloads

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.

Notes

Compliance with Ethical Standards

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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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Jose Carlos Flores-González
    • 1
    • 4
    Email author return OK on get
  • Ana Estalella-Mendoza
    • 1
    • 4
  • Patricia Rodríguez-Campoy
    • 1
    • 4
  • Mónica Saldaña-Valderas
    • 2
    • 4
  • Alfonso M. Lechuga-Sancho
    • 3
    • 4
  1. 1.Pediatric Intensive Care UnitPuerta del Mar University HospitalCádizSpain
  2. 2.Clinical Farmacology UnitPuerta del Mar University HospitalCadizSpain
  3. 3.Mother and Child Health, and Radiology DepartmentCádiz UniversityCadizSpain
  4. 4.Institute of Research and Innovation in Biomedical Sciences (INIBiCA)CadizSpain

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