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The Questionable Efficacy of Topical Pharyngeal Anesthesia in Combination with Propofol Sedation in Gastroscopy

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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 × HR were compared at 5 time points: on arrival, after 5 spontaneous breaths, when estimated brain concentration of propofol, Ce, reached 3.5 μg/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.

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Conflict of interest

The authors have state that they have no interests which might be perceived as causing a conflict or a bias.

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Authors and Affiliations

  1. Department of Anesthesiology, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kuei Shan Hsiang, Taoyuan, 333, Taiwan

    Hsin-I Tsai, Yung-Fung Tsai, Shiue-Chin Liou, Chih-Chung Lin & Huang-Ping Yu

  2. College of Medicine, Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan

    Hsin-I Tsai, Yung-Fung Tsai, Shiue-Chin Liou, Chih-Chung Lin & Huang-Ping Yu

  3. Department of Gastroenterology, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Ming-Yao Su

  4. Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan

    Chee-Jen Chang

  5. Biostatistical Center for Clinical Research, Chang Gung Memorial Hospital, Taoyuan, Taiwan

    Chee-Jen Chang

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  1. Hsin-I Tsai
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  2. Yung-Fung Tsai
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Correspondence to Huang-Ping Yu.

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Tsai, HI., Tsai, YF., Liou, SC. et al. The Questionable Efficacy of Topical Pharyngeal Anesthesia in Combination with Propofol Sedation in Gastroscopy. Dig Dis Sci 57, 2519–2526 (2012). https://doi.org/10.1007/s10620-012-2206-4

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  • DOI: https://doi.org/10.1007/s10620-012-2206-4

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