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Mahawongkajit P, Soonthornkes N. Comparative effectiveness of lidocaine sprays between sitting and supine position for patients undergoing upper gastrointestinal endoscopy: a prospective randomized controlled trial. Surg Endosc 2021; 36:5067-5075. [PMID: 34750705 DOI: 10.1007/s00464-021-08868-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Topical pharyngeal anesthesia has improved esophagogastroduodenoscopy (EGD) efficiency with smooth insertion, reducing pain and discomfort. Lidocaine spray is one of the safe and widely used methods. In practice, the patients walk, sit in a wheelchair, or lie on a trolley bed, and the lidocaine sprays are applied to those in sitting or supine positions for pre-endoscopic preparation. Although there is no current guidance technique, this study aims to compare the effects of lidocaine sprays between sitting (Group A; Gp A) and supine positions (Group B; Gp B) for patients undergoing unsedated EGD. METHODS This study was a single-center prospective randomized controlled trial. Unsedated EGD patients were randomly allocated the lidocaine spray in sitting or lidocaine spray in the supine position. RESULTS Lidocaine spray treatments were significantly different in the gag reflex (NRS; Gp A: 1.28 ± 0.67, Gp B: 1 ± 0.63, p = 0.0003), ease of esophageal instrumentation (NRS; Gp A: 7.68 ± 0.91, Gp B: 7.95 ± 0.66, p = 0.0042), and pain score (NRS; Gp A: 5.16 ± 2.08, Gp B: 4.53 ± 1.93, p = 0.0059). When considering modified Mallampati classification (MMC), MMC classes III and IV were significantly different in the same direction but MMC classes I and II were not. CONCLUSION The technique of spraying in the supine position was associated with less gagging, less pain, and easier esophageal instrumentation, especially in patients with MMC classes III and IV.
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Affiliation(s)
- Prasit Mahawongkajit
- Department of Surgery, Faculty of Medicine, Thammasat University (Rangsit Campus), 95/209 Moo 18, Paholyothin Road, Amphur Klongluang, Pathumthani, 12120, Thailand.
| | - Neranchala Soonthornkes
- Department of Anesthesiology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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2
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Mahawongkajit P, Talalak N, Soonthornkes N. Comparison of Lidocaine Spray and Lidocaine Ice Popsicle in Patients Undergoing Unsedated Esophagogastroduodenoscopy: A Single Center Prospective Randomized Controlled Trial. Clin Exp Gastroenterol 2021; 14:209-216. [PMID: 34079324 PMCID: PMC8164666 DOI: 10.2147/ceg.s301163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/10/2021] [Indexed: 12/11/2022] Open
Abstract
Purpose Esophagogastroduodenoscopy (EGD) under topical pharyngeal anesthesia has the advantage of avoiding the unwanted cardiopulmonary adverse events experienced following intravenous sedation. Lidocaine spray is a common anesthetic option and is safe for unsedated EGD. Although several studies have compared different topical anesthetic agents, their formulations, and delivery techniques, questions still remain concerning the optimal mode of administration. We have designed a lidocaine formulation in the form of an ice popsicle and compared its effectiveness and tolerability with lidocaine spray in patients undergoing unsedated EGD. Methods This was a single-center prospective randomized controlled trial. Unsedated EGD patients were randomly allocated the lidocaine spray [Group (Gp) A] or lidocaine ice popsicle (Gp B) formulation. Results In total, 204 unsedated EGD patients were evaluated. Compared to the spray, the lidocaine ice popsicle group showed better scores for effects in terms of endoscopist satisfaction (Gp A, 7.28±1.44; Gp B, 7.8±0.89; p=0.0022), gag reflex (Gp A, 1.3±0.66; Gp B, 1.02±0.61; p=0.0016), patient satisfaction (Gp A, 7.74±0.82; Gp B, 8.08±0.82; p=0.0039), discomfort (Gp A, 6.54±1.34; Gp B, 5.95±1.21; p=0.0012), and pain (Gp A, 5.38±1.85; Gp B, 4.51±2.01; p=0.0015). Conclusion Both the lidocaine spray and ice popsicle formulations are safe, effective options for diagnostic EGD with the ice popsicle exhibiting better performance. We propose the lidocaine ice popsicle formulation for topical pharyngeal anesthesia in patients undergoing unsedated diagnostic EGD and suggest it may be a suitable option during the COVID-19 pandemic. Clinical Trial Register Thai Clinical Trials Registry (TCTR) number TCTR20190502001.
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Affiliation(s)
- Prasit Mahawongkajit
- Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand
| | - Nantawat Talalak
- Department of Surgery, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand
| | - Neranchala Soonthornkes
- Department of Anesthesiology, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand
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3
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Watanabe J, Ikegami Y, Tsuda A, Kakehi E, Kanno T, Ishikawa S, Kataoka Y. Lidocaine spray versus viscous lidocaine solution for pharyngeal local anesthesia in upper gastrointestinal endoscopy: Systematic review and meta-analysis. Dig Endosc 2021; 33:538-548. [PMID: 32573016 DOI: 10.1111/den.13775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/14/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES There are two major methods for local anesthesia by lidocaine before upper gastrointestinal endoscopy: simple spray and viscous solution. We aimed to assess the efficacy and safety by meta-analysis between these two methods. METHODS We searched PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases through October 2019 to perform meta-analyses using random-effects models. The primary outcomes were participants' pain/discomfort, satisfaction, and anaphylactic shock. Three reviewers independently searched for articles, extracted data, and assessed the risk of bias. We evaluated the certainty of evidence based on the Grading of Recommendations, Assessment, Development, and Evaluation approach. This study was registered in PROSPERO (CRD42020155611). RESULTS We included seven randomized controlled trials (2667 participants). The participants' pain/discomfort may be similar between the lidocaine spray and viscous solution [standardized mean difference 0.03, 95% confidence intervals (CI) -0.37 to 0.42; I2 = 93%; low certainty of evidence]. The lidocaine spray probably increased participants' satisfaction compared with the viscous solution (relative risk 1.22; 95% CI, 1.02 to 1.47; I2 = 47%; moderate certainty of evidence). No anaphylactic shock occurred in four studies (low certainty of evidence). Four studies had high risks of selection bias. CONCLUSION The use of lidocaine spray for local anesthesia provided better satisfaction scores than the viscous solution, and both methods have the same effect with regards to the control of discomfort and pain. Further studies in large multicenter randomized controlled trials with a pre-registration protocol are needed.
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Affiliation(s)
- Jun Watanabe
- Center for Community Medicine, Jichi Medical University, Tochigi, Japan.,Department of Surgery, Tottori Prefectural Central Hospital, Tottori, Japan.,Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Yusuke Ikegami
- General Internal Medicine, Minami-Nara General Medical Center, Nara, Japan
| | - Ayumi Tsuda
- Department of Surgery, Tottori Prefectural Central Hospital, Tottori, Japan
| | - Eiichi Kakehi
- Department of General Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Takeshi Kanno
- Division of Gastroenterology, Tohoku University Hospital, Miyagi, Japan
| | | | - Yuki Kataoka
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan.,Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
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4
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Chow EPF, Maddaford K, Trumpour S, Fairley CK. Translating mouthwash use for gonorrhoea prevention into a public health campaign: identifying current knowledge and research gaps. Sex Health 2020; 16:433-441. [PMID: 31099331 DOI: 10.1071/sh18237] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/13/2019] [Indexed: 11/23/2022]
Abstract
The gonorrhoea rate among gay and bisexual men who have sex with men (MSM) has been increasing rapidly in many Western countries. Furthermore, gonorrhoea is becoming increasingly resistant to antibiotics and only limited options remain for treatment. Recent evidence suggests that the oropharynx may play an important role in gonorrhoea transmission. It is hypothesised that reducing the prevalence of oropharyngeal gonorrhoea will also reduce the population incidence of gonorrhoea. Mouthwash has been proposed as a novel non-antibiotic intervention to prevent oropharyngeal gonorrhoea; hence, reducing the probability of antibiotic resistance developing. However, its efficacy is yet to be confirmed by a randomised controlled trial - the findings of which will be available in 2019. If the trial shows mouthwash is effective in preventing gonorrhoea, this finding could potentially be translated into a public health campaign to increase the mouthwash use in the MSM population. This article summarises the current evidence of the effectiveness of mouthwash against gonorrhoea and discusses the potential literature gaps before implementing the mouthwash intervention at a population level.
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Affiliation(s)
- Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia; and Corresponding author.
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia
| | - Sabrina Trumpour
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Vic. 3053, Australia; and Central Clinical School, Monash University, 99 Commercial Road, Melbourne, Vic. 3004, Australia
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5
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Khodadoostan M, Sadeghian S, Safaei A, Shavakhi AR, Shavakhi A. Viscous lidocaine solution versus lidocaine spray for pharyngeal local anesthesia in upper gastroesophageal endoscopy. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2018; 23:102. [PMID: 30595710 PMCID: PMC6282542 DOI: 10.4103/jrms.jrms_579_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/20/2017] [Accepted: 09/20/2018] [Indexed: 11/22/2022]
Abstract
Background: Advantage of using local sedation during upper gastrointestinal endoscopy (UGE) is still challenging. In the current study, the effect of lidocaine spray versus lidocaine viscous solution for pharyngeal local anesthesia during UGE has been compared. Materials and Methods: This is a randomized clinical trial conducted on 130 patients conducting UGE in 2013. Patients were randomly divided into two groups of viscous lidocaine solution (Group V) and lidocaine spray (Group S). Patients’ tolerance, satisfaction, pain/discomfort, and anxiety (based on 11-point numerical score scale) and ease of endoscopy were compared. Results: Ease of procedure, patients’ tolerance, and patients’ satisfaction were not statistically different between two groups (P > 0.05). Patients’ pain/discomfort and anxiety during endoscopy were significantly different between groups (P < 0.05). Conclusion: As a conclusion, there was not any difference between two groups except for pain, discomfort, and anxiety that was higher in those who administered spray that might be due to the method of usage.
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Affiliation(s)
- Mahsa Khodadoostan
- Department of Gastroenterology and Hepatology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sina Sadeghian
- Department of Gastroenterology and Hepatology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Safaei
- Department of Gastroenterology and Hepatology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Reza Shavakhi
- Department of Gastroenterology and Hepatology, Shahr-e-Kord University of Medical Sciences, Shahr-e-Kord, Iran
| | - Ahmad Shavakhi
- Department of Gastroenterology and Hepatology, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Topical Anesthesia for Endoscopic Office-based Procedures of the Upper Aerodigestive Tract. J Voice 2018; 33:732-746. [PMID: 30017430 DOI: 10.1016/j.jvoice.2018.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 02/09/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Over the last two decades, an increase in office-based procedures under topical anesthesia in laryngology and head and neck oncology has occurred. Adequate anesthesia in the nasal cavity, pharynx, and larynx is essential for successful performance of these procedures. Our goal is to provide an objective summary on the available local anesthetics, methods of application, local secondary effects, efficacy, and complications. MATERIAL AND METHODS A descriptive review of literature on topical anesthesia for office-based procedures in laryngology and head and neck oncology was performed. RESULTS Lidocaine is the most applied and investigated topical anesthetic. Topical anesthesia results in decreased sensory function without impairing motor function of the pharynx and larynx. For the nasal cavity, cotton pledgets soaked in anesthetic spray and decongestant, or anesthetic gel, are effective. For the pharynx, anesthetic spray is the most frequently used and effective method. For the larynx, applying local anesthesia through a catheter through the working channel of the endoscope or anesthetic injection through the cricothyroid membrane is effective. Studies comparing the most effective application methods for each anatomical site are lacking. Complications of topical lidocaine administration are rare. CONCLUSIONS By properly applying topical anesthesia to the upper aerodigestive tract, several surgical procedures in laryngology and head and neck oncology can be performed in the outpatient clinic under topical anesthesia instead of the operating room under general anesthesia. Lidocaine is the most investigated anesthetic, with adequate efficacy and few complications. Studies that determine the most effective application methods are still wanting.
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Gore SS, Rathi N, Ganvir AY, Potdar NA, Apte MK, Marathe TR, Nair AG, Shinde CA. Nontraumatic subperiosteal orbital hemorrhage following upper gastrointestinal endoscopy. Indian J Ophthalmol 2018; 66:877-879. [PMID: 29786011 PMCID: PMC5989525 DOI: 10.4103/ijo.ijo_123_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Subperiosteal hemorrhages are typically the result of blunt orbital or facial trauma. Nontraumatic subperiosteal hemorrhages are uncommon and are usually attributed to increase in central venous pressure and bleeding disorders. Here, we report the case of a 38-year-old female who underwent an upper gastrointestinal (GI) endoscopy and developed bilateral nontraumatic subperiosteal hemorrhages that resolved with conservative treatment. Here, we discuss the source of bleeding and the mechanisms for the occurrence of orbital subperiosteal bleeds. GI surgeons and ophthalmologists should be sensitive to the possibility that orbital hemorrhage that can occur following endoscopy, especially when retching or gagging occurs during the procedure.
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Affiliation(s)
- Swaranjali S Gore
- Department of Ophthalmology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra, India
| | - Neha Rathi
- Department of Ophthalmology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra, India
| | - Amol Y Ganvir
- Department of Ophthalmology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra, India
| | - Nayana A Potdar
- Department of Ophthalmology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra, India
| | - Monisha K Apte
- Department of Ophthalmology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra, India
| | - Trupti R Marathe
- Department of Ophthalmology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra, India
| | - Akshay Gopinathan Nair
- Department of Ophthalmology, Lokmanya Tilak Municipal General Hospital and Medical College; Department of Ophthalmic Plastic Surgery and Ocular Oncology Services, Advanced Eye Hospital and Institute, Mumbai, Maharashtra, India
| | - Chhaya A Shinde
- Department of Ophthalmology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra, India
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8
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Hayashi T, Asahina Y, Waseda Y, Kitamura K, Kagaya T, Seike T, Okada K, Inada Y, Takabatake H, Orita N, Yanase Y, Yamashita T, Ninomiya I, Yoshimura K, Kaneko S. Lidocaine spray alone is similar to spray plus viscous solution for pharyngeal observation during transoral endoscopy: a clinical randomized trial. Endosc Int Open 2017; 5:E47-E53. [PMID: 28191496 PMCID: PMC5291156 DOI: 10.1055/s-0042-120414] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background and study aims It is important to examine the pharynx during upper gastrointestinal endoscopy. Pharyngeal anesthesia using topical lidocaine is generally used as pretreatment. In Japan, lidocaine viscous solution is the anesthetic of choice, but lidocaine spray is applied when the former is considered insufficient. However, the relationship between the extent of pharyngeal anesthesia and accuracy of observation is unclear. We compared the performance of lidocaine spray alone versus lidocaine spray combined with lidocaine viscous solution for pharyngeal observation during transoral endoscopy. Patients and methods In this prospective, double-blinded, randomized clinical trial conducted between January and March 2015, 327 patients were randomly assigned to lidocaine spray alone (spray group, n = 157) or a combination of spray and viscous solution (combination group, n = 170). We compared the number of pharyngeal observable sites (non-inferiority test), pain by visual analogue scale, observation time, and the number of gag reflexes between the two groups. Results The mean number of images of suitable quality taken at the observable pharyngeal sites in the spray group was 8.33 (95 % confidence interval [CI]: 7.94 - 8.72) per patient, and 8.77 (95 % CI: 8.49 - 9.05) per patient in the combination group. The difference in the number of observable pharyngeal sites was - 0.44 (95 % CI: - 0.84 to - 0.03, P = 0.01). There were no differences in pain, observation time, or number of gag reflexes between the 2 groups. Subgroup analysis of the presence of sedation revealed no differences between the two groups for the number of pharyngeal observation sites and the number of gag reflexes. However, the number of gag reflexes was higher in the spray group compared to the combination group in a subgroup analysis that looked at the absence of sedation. Conclusions Lidocaine spray for pharyngeal anesthesia was not inferior to lidocaine spray and viscous solution in terms of pharyngeal observation. It was considered that lidocaine viscous solution was unnecessary for pharyngeal observation. UMIN000016073.
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Affiliation(s)
- Tomoyuki Hayashi
- Department of Gastroenterology, Kanazawa
University Hospital, Ishikawa, Japan,Corresponding author Tomoyuki Hayashi,
MD Kanazawa University
Hospital13-1 Takaramachi, Kanazawa, Ishikawa
920-8641Japan+81-76-234-4250
| | - Yoshiro Asahina
- Department of Gastroenterology, Kanazawa
University Hospital, Ishikawa, Japan
| | - Yohei Waseda
- Department of Gastroenterology, Kanazawa
University Hospital, Ishikawa, Japan
| | - Kazuya Kitamura
- Department of Gastroenterology, Kanazawa
University Hospital, Ishikawa, Japan
| | - Takashi Kagaya
- Department of Gastroenterology, Kanazawa
University Hospital, Ishikawa, Japan
| | - Takuya Seike
- Department of Gastroenterology, Kanazawa
University Hospital, Ishikawa, Japan
| | - Kazuhiro Okada
- Department of Gastroenterology, Kanazawa
University Hospital, Ishikawa, Japan
| | - Yuki Inada
- Department of Gastroenterology, Kanazawa
University Hospital, Ishikawa, Japan
| | - Hisashi Takabatake
- Department of Gastroenterology, Kanazawa
University Hospital, Ishikawa, Japan
| | - Noriaki Orita
- Department of Gastroenterology, Kanazawa
University Hospital, Ishikawa, Japan
| | - Yuko Yanase
- Department of Gastroenterology, Kanazawa
University Hospital, Ishikawa, Japan
| | - Tatsuya Yamashita
- Department of Gastroenterology, Kanazawa
University Hospital, Ishikawa, Japan
| | - Itasu Ninomiya
- Department of Gastrointestinal Surgery,
Kanazawa University Hospital, Ishikawa, Japan
| | - Kenichi Yoshimura
- Innovative Clinical Research Center, Kanazawa
University Hospital, Ishikawa, Japan
| | - Shuichi Kaneko
- Department of Gastroenterology, Kanazawa
University Hospital, Ishikawa, Japan
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Amornyotin S. Adverse Event Rate of Unsedated Esophagogastroduodenoscopy: a Comparison Between Healthy Adults and Cirrhotic Patients. GASTROENTEROLOGY & HEPATOLOGY: OPEN ACCESS 2016; 5. [DOI: 10.15406/ghoa.2016.05.00142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
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10
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Amornyotin S. Dexmedetomidine in gastrointestinal endoscopic procedures. World J Anesthesiol 2016; 5:1-14. [DOI: 10.5313/wja.v5.i1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 10/07/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal endoscopy is the gold standard in the examination and the treatment of the diseases of gastrointestinal system, but the disadvantage of being painful process. At this point the sedative and analgesic agents may be important. Dexmedetomidine is a new sedoanalgesic agent which is alternative to benzodiazepines and opioids. It has analgesia, amnesia, sedative and anxiolytic properties. The use of dexmedetomidine as the sole anesthetic agent and as the adjuvant analgesic agent has been published but has not been approved because of the inconsistency of efficacy and safety. The author has been collected the published papers in the literature. This article is aimed to describe the use of dexmedetomidine in various gastrointestinal endoscopic procedures.
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Amornyotin S. Topical Pharyngeal Anesthesia for Unsedated Esophagogastroduodenoscopy Procedure in Sick Patients. JOURNAL OF ANESTHESIA & CRITICAL CARE: OPEN ACCESS 2016; 4. [DOI: 10.15406/jaccoa.2016.04.00134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
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12
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Amornyotin S. Unsedated Esophagogastroduodenoscopy in Cirrhotic Patients: An Impact of Topical Pharyngeal Anesthesia. JOURNAL OF ANESTHESIA & CRITICAL CARE: OPEN ACCESS 2015; 3. [DOI: 10.15406/jaccoa.2015.03.00106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
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Salale N, Treldal C, Mogensen S, Rasmussen M, Petersen J, Andersen O, Jacobsen J. Bupivacaine Lozenge Compared with Lidocaine Spray as Topical Pharyngeal Anesthetic before Unsedated Upper Gastrointestinal Endoscopy: A Randomized, Controlled Trial. CLINICAL MEDICINE INSIGHTS. GASTROENTEROLOGY 2014; 7:55-9. [PMID: 25374463 PMCID: PMC4213191 DOI: 10.4137/cgast.s18019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/25/2014] [Accepted: 08/04/2014] [Indexed: 11/05/2022]
Abstract
Unsedated upper gastrointestinal endoscopy (UGE) can induce patient discomfort, mainly due to a strong gag reflex. The aim was to assess the effect of a bupivacaine lozenge as topical pharyngeal anesthetic compared with standard treatment with a lidocaine spray before UGE. Ninety-nine adult outpatients undergoing unsedated diagnostic UGE were randomized to receive either a bupivacaine lozenge (L-group, n = 51) or lidocaine spray (S-group, n = 42). Primary objective was assessment of patient discomfort including acceptance of the gag reflex during UGE. The L-group assessed the discomfort significantly lower on a visual analog scale compared with the S-group (P = 0.02). There was also a significant difference in the four-point scale assessment of the gag reflex (P = 0.03). It was evaluated as acceptable by 49% in the L-group compared with 31% in the S-group. A bupivacaine lozenge compared with a lidocaine spray proved to be a superior option as topical pharyngeal anesthetic before an UGE.
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Affiliation(s)
- Nesrin Salale
- Section for Pharmaceutical Design and Drug Delivery, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark. ; Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Charlotte Treldal
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Stine Mogensen
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Mette Rasmussen
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Janne Petersen
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Ove Andersen
- Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark
| | - Jette Jacobsen
- Section for Pharmaceutical Design and Drug Delivery, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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14
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Hsieh YH, Lin HJ, Hsieh JJ, Tseng KC, Tseng CW, Hung TH, Leung FW. Meperidine as the single sedative agent during esophagogastroduodenoscopy, a double-blind, randomized, controlled study. J Gastroenterol Hepatol 2013; 28:1167-73. [PMID: 23431993 DOI: 10.1111/jgh.12183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM In Taiwan, unsedated esophagogastroduodenoscopy (EGD) is widely used, but it is uncomfortable for some patients. While meperidine has been adopted in colonoscopy, its use in EGD has not received extensive attention. This was a prospective study to investigate the use of meperidine as a single sedative agent during EGD. METHODS One hundred and forty patients were randomized to receive either 25-mg meperidine (n = 70) or placebo (n = 70) by intramuscular injection before EGD. The primary outcome was patient discomfort scores. The secondary outcomes included patient, endoscopist, and EGD-related variables. RESULTS Patients in the meperidine group reported less discomfort during esophageal intubation (median score of 2.0 and interquartile range [IQR] of 0-4.0 vs median score of 4.8 and IQR of 1.7-7.0, respectively; P < 0.001) and during the procedure (median score of 1.0 [IQR 0-3.1] vs 3.5 [IQR 0-5.6], P = 0.001) than patients in the placebo group. The endoscopist found patients in the meperidine group had better tolerance during esophageal intubation (median score of 1.0 [IQR 0-2.0] vs 2.0 [IQR 1.0-3.0], P = 0.021) and during the procedure (median score of 0 [IQR 0-1.0] vs 1.0 [IQR 0-3.0], P < 0.001). After the procedure more patients in the meperidine group (71.4% vs 35.7%, P < 0.001) experienced self-limited dizziness that prolonged recovery by ∼3.7 min. CONCLUSIONS After receiving meperidine injection, patients had better tolerance and less discomfort during diagnostic EGD (NCT01547520).
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Affiliation(s)
- Yu-Hsi Hsieh
- Division of Gastroenterology, Department of Medicine, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan.
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Mogensen S, Treldal C, Feldager E, Pulis S, Jacobsen J, Andersen O, Rasmussen M. New lidocaine lozenge as topical anesthesia compared to lidocaine viscous oral solution before upper gastrointestinal endoscopy. Local Reg Anesth 2012; 5:17-22. [PMID: 22915898 PMCID: PMC3417978 DOI: 10.2147/lra.s30715] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the effect and acceptance of a new lidocaine lozenge compared with a lidocaine viscous oral solution as a pharyngeal anesthetic before upper gastrointestinal endoscopy (UGE), a diagnostic procedure commonly performed worldwide during which many patients experience severe discomfort mostly because of the gag reflex. Participants The single-blinded, randomized, controlled study involved 110 adult patients undergoing diagnostic UGE at the Department of Gastroenterology, Hvidovre University Hospital, Denmark. Methods The patients were randomized to receive either 100 mg lidocaine as a lozenge or 5 mL lidocaine viscous oral solution 2%. Intravenous midazolam was administered if needed. The effect of a lidocaine lozenge in reducing patient discomfort, including the gag reflex, during UGE compared with a lidocaine oral solution was assessed. Results Questionnaires from the patients showed that the gag reflex was acceptable for 64% in the lozenge group compared with 33% in the oral solution group (P = 0.0072). UGE was evaluated as acceptable by 69% in the lozenge group compared with 39% in the oral solution group (P = 0.0092). The taste was evaluated as good by 78% in the lozenge group (P < 0.0001), and 82% found the lozenge to have good texture (P < 0.0001). Conclusion The lozenge reduced the gag reflex, diminished patients’ discomfort during UGE, and was evaluated as having a good taste and texture. The lozenge improved patients’ acceptance of UGE.
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Affiliation(s)
- Stine Mogensen
- Clinical Research Centre, Hvidovre University Hospital, Copenhagen, Denmark
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Jiménez-Puente G, Hidalgo-Isla M. [Use of topical pharyngeal anaesthesia in esophagogastroduodenoscopy in unsedated patients]. ENFERMERIA CLINICA 2011; 21:30-4. [PMID: 21334240 DOI: 10.1016/j.enfcli.2010.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Revised: 07/05/2010] [Accepted: 07/13/2010] [Indexed: 10/18/2022]
Abstract
AIM Evaluation of effect on tolerance of topical pharyngeal anaesthesia with a lidocaine spray in esophagogastroduodenoscopy (EGD), and possible secondary factors that could influence it. METHODS A prospective, experimental, randomized, open-label study was performed in our Endoscopy Unit during January 2010. Outpatients (109) were recruited prospectively and randomized between two groups: L group (52), who received lidocaine (50 mg Xilonibsa 10% before examination), and C group (57) who did not. Sedated patients were not included in this study. Age, sex, Mallampati index (lower I and II; higher III and IV), endoscopist, complications and score (0-100; visual analogue scale) was recorded after each EGD. RESULTS There were no statistical differences between the two groups as regards patient tolerance. However in stratified analysis the application of lidocaine modified the results in two out of the six endoscopists and improved the scores in patients with a higher Mallampati Index (L group 61.8 ± 24 and C group 47.7 ± 32). Significant differences were also observed in the scores on patient tolerance between the endoscopist (operator dependent factor), regardless of the use of topical pharyngeal anaesthesia or not. CONCLUSIONS The systematic use of lidocaine in EGD is safe but does not improve the tolerance in all outpatients. Only the Mallampati index has been identified as a prognosis factor of good response to lidocaine administration. Additionally the nursing-endoscopist could be a very important factor in the scores obtained independently of lidocaine.
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Affiliation(s)
- Gema Jiménez-Puente
- Unidad de Enfermería de Endoscopia Digestiva, Hospital Infanta Cristina, Parla, Madrid, España.
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