Investigation of Efficacy of Lidocaine Spray for Sedated Esophagogastroduodenoscopy in Children

Abstract

PurposeOur aim in this study is to investigate efficacy of topical lidocaine spray for sedated esophagogastroduodenoscopy (EGD) in children.MethodsThe endoscopy of children aged between 3-18 years who underwent EGD in our endoscopy unit. Intravenous (IV) midazolam and ketamine were used for sedation. Prior to sedation, endoscopy nurse applied topical lidocaine 10% with pump spray at 1 mg/kg dose in group 1, and distilled water via identically scaled pump spray in group 2, in a double blinded fashion.ResultsSedation was not applied in 24.1% of the cases in topical lidocaine spray group (LS group) and in 5.7% of the cases in distilled water spray group (DS group). Gag reflex was observed in 6.5% of cases in LS group and 33.3% of cases in DS group (p=0.024), increased oral secretion was observed in 9.3% of cases in LS group and 51.7% of cases in DS group (p=0.038), sore throat was observed in 3.7% of cases in LS group and 35.6% of cases in DS group (p=0.019) and the difference was statistically significant.ConclusionThe study showed that topical pharyngeal lidocaine reduces both requirement and amount of IV sedation before EGD in children and sore throat, gag reflex and decreased oral secretion increase.

Effectivity of benzydamine hydrochloride gargle to reduce propofol consumption in endoscopic retrograde cholangiopancreatography procedure: a randomized controlled trial

“…The results showed that cumulative propofol requirements in the benzydamine hydrochloride group was significantly less than in the control group. The result is consistent [3,5]. However, lidocaine spray might cause irritation, nausea, vomiting, and dysphagia.…”

“…Topical analgesic is often added to reduce throat irritation incidence which can trigger gag reflex when an endoscopic probe is inserted. Combination of propofol and topical analgesic is an alternative to reduce propofol consumption and to provide adequate sedation while avoiding propofol side effects [3,5].…”

British Society of Gastroenterology guidelines on sedation in gastrointestinal endoscopy

“…Level of agreement: 100% Good evidence shows that combining sedation with oropharyngeal anaesthesia improves tolerance and comfort of gastroscopy. [152][153][154][155] Topical pharyngeal anaesthesia reduces the gag reflex in patients sedated with propofol. 156 However, concerns have been raised as to whether the combination of throat spray and sedation increases the risk of aspiration pneumonia 152 157-159 ; no published evidence is available to substantiate these concerns.…”

Benzydamine hydrochloride: an overview on a well-established drug with news in mechanisms of action

“…The combination of sedation with topical anaesthetics in endoscopic procedures is not new and has been tested also in previous studies, where lidocaine in the form of spray or gel was locally applied. 22 However, benzydamine HCl mouthwash is becoming an alternative for this approach in the clinical practice as it can induce lower side effects than lidocaine.…”