Anaesthesia and sedation for gastrointestinal endoscopy

Leslie, Kate; Stonell, C.

doi:10.1097/01.aco.0000168328.02444.3c

Cited by 18 publications

(13 citation statements)

References 48 publications

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“…Upper gastrointestinal endoscopy (UGE) is a common diagnostic procedure performed throughout the world 1. Many patients experience severe discomfort during UGE, mostly because of the strong gag reflex that occurs when the endoscope is passed through the pharynx 2…”

Section: Introductionmentioning

confidence: 99%

New lidocaine lozenge as topical anesthesia compared to lidocaine viscous oral solution before upper gastrointestinal endoscopy

Mogensen

Treldal²,

Feldager³

et al. 2012

LRA

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ObjectiveTo 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.ParticipantsThe single-blinded, randomized, controlled study involved 110 adult patients undergoing diagnostic UGE at the Department of Gastroenterology, Hvidovre University Hospital, Denmark.MethodsThe 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.ResultsQuestionnaires 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).ConclusionThe 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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Section: Introductionmentioning

confidence: 99%

New lidocaine lozenge as topical anesthesia compared to lidocaine viscous oral solution before upper gastrointestinal endoscopy

Mogensen

Treldal²,

Feldager³

et al. 2012

LRA

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“…While some investigators propose that sedation-related complications may develop (6,7), many have reported that conscious sedation increases comfort during upper gastrointestinal endoscopy and reduces cardiac stress (8,9).…”

Section: Introductionmentioning

confidence: 99%

Effects of sedation during upper gastrointestinal endoscopy on endocrine response and cardiorespiratory function

Yetkın

Oba

Uludağ

et al. 2007

Braz J Med Biol Res

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Upper gastrointestinal endoscopy is often accompanied by tachycardia which is known to be an important pathogenic factor in the development of myocardial ischemia. The pathogenesis of tachycardia is unknown but the condition is thought to be due to the endocrine response to endoscopy. The purpose of the present study was to investigate the effects of sedation on the endocrine response and cardiorespiratory function. Forty patients scheduled for diagnostic upper gastrointestinal endoscopy were randomized into 2 groups. While the patients in the first group did not receive sedation during upper gastrointestinal endoscopy, the patients in the second group were sedated with intravenous midazolam at the dose of 5 mg for those under 65 years or 2.5 mg for those aged 65 years or more. Midazolam was administered by slow infusion. In both groups, blood pressure, ECG tracing, heart rate, and peripheral oxygen saturation (SpO 2 ) were monitored during endoscopy. In addition, blood samples for the determination of cortisol, glucose and C-reactive protein levels were obtained from patients in both groups prior to and following endoscopy. Heart rate and systolic arterial pressure changes were within normal limits in both groups. Comparison of the two groups regarding the values of these two parameters did not reveal a significant difference, while a statistically significant reduction in SpO 2 was found in the sedation group. No significant differences in serum cortisol, glucose or C-reactive protein levels were observed between the sedated and non-sedated group. Sedation with midazolam did not reduce the endocrine response and the tachycardia developing during upper gastrointestinal endoscopy, but increased the reduction in SpO 2 .

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“…Patients presenting for colonoscopy harbour varying expectations, experience varying degrees of discomfort and exhibit varying sensitivity to sedative drugs [1]. Patient‐controlled sedation (PCS) allows patients to match their sedation requirement to perceived noxious stimulation during the procedure, in a manner analogous to patient‐controlled analgesia (PCA).…”

mentioning

confidence: 99%

Effect‐site targeted patient‐controlled sedation with propofol: comparison with anaesthetist administration for colonoscopy

2006

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SummaryPatient-controlled sedation (PCS) allows patients to match their sedation requirement to perceived discomfort. The significant delay in onset of sedation may be overcome with effect-site steered target controlled infusion, but previously only trials in volunteers have been carried out. We therefore conducted a randomised, double-blind controlled trial comparing effect-site steered propofol PCS with anaesthetist-administered propofol sedation in 40 patients presenting for colonoscopy. The initial effect-site target in the PCS group was 0.8 lg.ml )1 , increment was 0.1 lg.ml )1 and lockout was 3 min. Patient and endoscopist satisfaction and operating conditions were similar between the two groups. PCS patients were sedated more slowly (13 [7.1] vs. 3 [1.1] min; p < 0.0001) and less deeply (minimum BIS value: 71 [16] vs. 58 [15]; p = 0.13) than anaesthetist-administered propofol sedation patients. More of the latter patients were hypotensive, but all patients had similar recollection of events during the procedure and similar quality of recovery.

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Anaesthesia and sedation for gastrointestinal endoscopy

Abstract: There is still much scope to research and refine sedation techniques for endoscopy. We believe that the involvement of anaesthesiologists in this research is vital.

Cited by 18 publications

References 48 publications

New lidocaine lozenge as topical anesthesia compared to lidocaine viscous oral solution before upper gastrointestinal endoscopy

New lidocaine lozenge as topical anesthesia compared to lidocaine viscous oral solution before upper gastrointestinal endoscopy

Effects of sedation during upper gastrointestinal endoscopy on endocrine response and cardiorespiratory function

Effect‐site targeted patient‐controlled sedation with propofol: comparison with anaesthetist administration for colonoscopy

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