Lidocaine lollipop as single-agent anesthesia in upper GI endoscopy.
BACKGROUND
Conscious sedation is usually achieved during EGD by a combination of intravenous benzodiazepines and opiates; however, these have potential serious adverse effects. The addition of topical oropharyngeal anesthetics such as lidocaine may be useful. Recent data suggest that the administration of topical lidocaine by means of a lollipop is effective for endotracheal intubation and bronchoscopy.


OBJECTIVE
Our purpose was to evaluate the safety and efficacy of a lidocaine lollipop as single-agent anesthesia for EGD and to determine whether its use reduces the need for intravenous sedatives and analgesics.


METHODS
Single-blinded, randomized, prospective study.


METHODS
University hospital.


METHODS
50 patients undergoing diagnostic EGD.


METHODS
Patients were randomized to either lidocaine lollipop or lidocaine spray. Intravenous meperidine and midazolam were administered during the procedure as needed.


METHODS
The success and safety of local anesthesia by lidocaine lollipop in addition to the need for intravenous sedation.


RESULTS
Patients were equally randomized between the lollipop and the spray groups. The lollipop group had less gag reflex, accommodated scope introduction more, and tolerated the procedure better. Thirty-two percent of patients receiving the lollipop required sedation compared with 96% of patients in the spray group (P < .001). The majority in the lollipop group were satisfied with their mode of anesthesia compared with the spray group.


CONCLUSIONS
Lidocaine lollipop is a promising form of local oropharyngeal anesthesia for EGD. Its use resulted in sparing the use of intravenous sedation. It is well tolerated and safe and may be particularly important in the elderly, patients with comorbidities, and office-based endoscopy.
Ayoub
Chakib
C
Department of Anesthesia, American University of Beirut Medical Center, Beirut, Lebanon.
Skoury
Assaad
A
Abdul-Baki
Heitham
H
Nasr
Viviane
V
Soweid
Assaad
A
D000284:Administration, Oral; D000287:Administration, Topical; D000779:Anesthetics, Local / Q000008:administration & dosage*; D016292:Procedural Sedation / Q000379:methods; D004305:Dose-Response Relationship, Drug; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016037:Single-Blind Method
D000779:Anesthetics, Local; D008012:Lidocaine