Sedation, topical pharyngeal anesthesia and cardiorespiratory safety during gastroscopy.
OBJECTIVE
In a prospective, double-blind study, we examined the effects of routine sedation and pharyngeal anesthesia on cardiorespiratory parameters during gastroscopy.


BACKGROUND
Intravenous sedation and topical pharyngeal anesthesia are used to alleviate the discomfort during upper gastrointestinal endoscopy. Cardiorespiratory changes during gastroscopy are common.


METHODS
Two hundred fifty two consecutive outpatients undergoing gastroscopy were assigned into 4 groups: (1) sedation with intravenous midazolam and placebo throat spray (midazolam group), (2) placebo sedation and pharyngeal anesthesia with lidocaine throat spray (lidocaine group), (3) placebo sedation and placebo throat spray (placebo group), and (4) no intravenous cannula nor throat spray (control group). Arterial oxygen saturation (SaO2), systolic and diastolic blood pressure and continuous electrocardiogram were recorded before, during, and after the endoscopic procedure.


RESULTS
Gastroscopy increased heart rate in all study groups. Premedication with intravenous midazolam or lidocaine spray alleviated this rise (P<0.001, repeated measures analysis of variance) and decreased the incidence of tachycardia. Similarly, sedation with midazolam or topical pharyngeal anesthesia decreased the rise in systolic blood pressure (P<0.001). Midazolam produced lower SaO2 values during gastroscopy compared with lidocaine, placebo or control groups (P<0.001). However, episodes of desaturation (SaO2 </=92) were no more common in the midazolam group than in other groups.


CONCLUSIONS
Premedication with midazolam alleviated the rise in heart rate and systolic blood pressure but induced a statistically significant decrease in arterial oxygen saturation. However, gastroscopy proved to be a safe procedure both with and without sedation.
Ristikankare
Matti
M
Department of Medicine, Kuopio University Hospital, Kuopio, Finland. matti.ristikankare@kolumbus.fi
Julkunen
Risto
R
Heikkinen
Markku
M
Mattila
Matti
M
Laitinen
Tomi
T
Wang
Shi-Xuan
SX
Hartikainen
Juha
J
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced / Q000503:physiopathology; D001794:Blood Pressure / Q000187:drug effects*; D004311:Double-Blind Method; D015716:Electrocardiography, Ambulatory; D005260:Female; D005387:Finland; D005773:Gastroscopy; D006329:Heart Conduction System / Q000187:drug effects / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D008012:Lidocaine / Q000009:adverse effects; D008297:Male; D008874:Midazolam / Q000009:adverse effects; D008875:Middle Aged; D010100:Oxygen / Q000032:analysis; D010614:Pharynx / Q000187:drug effects*; D011446:Prospective Studies; D012143:Respiratory Physiological Phenomena / Q000187:drug effects*
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D008012:Lidocaine; D008874:Midazolam; D010100:Oxygen