Comparison the Effects of Ephedrine and Lidocaine in Treatment of Intraoperative Hiccups in Gynecologic Surgery under Sedation

Abstract

Background:This study aimed to evaluate and compare the therapeutic effects of ephedrine and lidocaine in treatment of intraoperative hiccups in gynecologic surgery under sedation.Materials and Methods:This randomized clinical trial in Isfahan was done on fifty female patients referring to Shahid Beheshti Hospital who needed to have sedation for medical interventions and they afflicted hiccups during surgery or sedation. Patients divided into two groups of 25 randomly assigned to one of the two groups of ephedrine or lidocaine. Ephedrine group received 5 mg/kg of medicine, while the lidocaine group was under treatment with 1 mg/kg lidocaine. Patients were monitored about systolic and diastolic blood pressure, MAP, heart rate, duration of hiccup, frequency of betterment, duration of intervention, and recovery at 15-min intervals of surgery and recovery.Results:Hiccups were resolved in 14 cases (56%) in the lidocaine group, while the improvement of such problem was achieved in 24 cases (96%) in ephedrine group (P < 0.001), so that the two groups did not have any significant difference in terms of the time of onset but the stop time of hiccups (relative to its start time) in the ephedrine group with the mean value of (2.40 ± 1.16) was significantly lower than the lidocaine group with the mean of 19.64 ± 22.76 min (P = 0.014). In addition, no complications were observed in the two groups.Conclusion:Ephedrine has been more successful than lidocaine as a stimulant in controlling hiccups, and it has been able to suppress hiccups in a higher percentage of patients at a shorter time.

Acute Hiccups Detected by Electromyographic Recordings During Resection of a Vestibular Schwannoma

“…15 Table provides an overview of all reports of hiccups during surgery. [16][17][18][19][20][21][22][23][24][25][26] In the case presented here, potential agents that might have triggered the hiccups were corticosteroids and opioids. 22,27 However, because the hiccups started while dissecting within the vicinity of the lower cranial nerves and relatively late during surgery, this seems unlikely.…”

“…To the best of our knowledge, we report here the first case of acute hiccups during vestibular schwannoma resection, which were recorded and securely identified as hiccups by means of spontaneous vocalis muscle EMG activity. Bahadoori et al 25…”

Fatal posterior circulation stroke with persistent hiccups, sinus arrest and post-hiccup syncope: A case report

“…Some scholars believe that the reflex arc of the hiccup is as follows: The afferent pathway of hiccups includes the sensory fibers of the vagal nerve, the phrenic nerve, and sympathetic nerves from Th6 to Th12; [12,13] ; The hiccup centers mainly include the medulla oblongata, the periaqueductal gray, subthalamic nuclei, phrenic nerve nuclei, reticular formation, and C3 to 5 cervical cord; [12][13][14] the hypothalamus and temporal lobe may have a greater influence on the arc; and; The efferent pathway of hiccups includes the phrenic nerves to the diaphragm, the external intercostal nerves (Th1-Th11) to the intercostal muscles, the cervical spinal nerves to the anterior scalene muscles, and the recurrent laryngeal portion of the vagal nerve to the glottis, which causes glottal closure. [12,14] Many diseases, such as stroke, [15,16] cancer, [17] surgery, [18,19] and COVID-19, [20] can cause hiccup, which can be divided into the following 4 categories according to the etiologies: central, peripheral, global and medication-derived causes. [21] The incidence rate of hiccups in ordinary inpatients is 0.054%, [22] in cancer patients is 3.9% to 4.5%, [23] and in stroke patients is approximately 0.3% (16 per 5309).…”

“…Many diseases, such as stroke, [15,16] cancer, [17] surgery, [18,19] and COVID-19, [20] can cause hiccup, which can be divided into the following 4 categories according to the etiologies: central, peripheral, global and medication-derived causes. [21] The incidence rate of hiccups in ordinary inpatients is 0.054%, [22] in cancer patients is 3.9% to 4.5%, [23] and in stroke patients is approximately 0.3% (16 per 5309).…”