title: The questionable efficacy of topical pharyngeal anesthesia in combination with propofol sedation in gastroscopy.
abstract: BACKGROUND
  Topical pharyngeal anesthesia as an adjunct to intravenous sedation to facilitate gastroscopy has been widely acknowledged; however, its efficacy has not been established when it is used in patients under deep sedation with propofol.
  
  
  OBJECTIVE
  To demonstrate the limited value of topical pharyngeal anesthesia in patients under moderate to deep sedation with propofol.
  
  
  METHODS
  One hundred and twenty-nine patients undergoing gastroscopy were prospectively randomized to receive 10 % lidocaine or distilled water topical spray as an adjunct to intravenous propofol via target-controlled infusion. Verbal and somatic responsiveness, presence of gag reflex and hiccup to esophageal intubation, and the overall ease of the procedure were evaluated by the anaesthetists and gastroenterologists. Hemodynamic parameters including peripheral oxygen saturation, systolic/diastolic blood pressure (SBP/DBP), heart rate (HR), bispectral index, and SBP × HR were compared at 5 time points: on arrival, after 5 spontaneous breaths, when estimated brain concentration of propofol, Ce, reached 3.5 μg/ml, on esophageal intubation, and on awakening.
  
  
  RESULTS
  No statistical difference was observed between the lidocaine and distilled water group in verbal or somatic responses, gag reflex or hiccups on esophageal intubation. Similarly, BIS, SBP, DBP, and HR showed no significant difference between the groups.
  
  
  CONCLUSIONS
  The use of topical pharyngeal anesthesia in combination with target-controlled infusion with propofol in the performance of diagnostic gastroscopy might be eliminated without adversely affecting patient care or outcomes.
authors.affiliation: Department of Anesthesiology, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kuei Shan Hsiang, Taoyuan 333, Taiwan. tsaic@hotmail.com
authors.forename: Hsin-I
authors.initials: HI
authors.lastname: Tsai
authors.forename: Yung-Fung
authors.initials: YF
authors.lastname: Tsai
authors.forename: Shiue-Chin
authors.initials: SC
authors.lastname: Liou
authors.forename: Ming-Yao
authors.initials: MY
authors.lastname: Su
authors.forename: Chih-Chung
authors.initials: CC
authors.lastname: Lin
authors.forename: Chee-Jen
authors.initials: CJ
authors.lastname: Chang
authors.forename: Huang-Ping
authors.initials: HP
authors.lastname: Yu
mesh_terms: D000328:Adult; D000336:Aerosols; D000368:Aged; D000772:Anesthesia, Local; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001794:Blood Pressure; D005260:Female; D005773:Gastroscopy; D006339:Heart Rate; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000187:drug effects*; D015742:Propofol
chemical_list: D000336:Aerosols; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D008012:Lidocaine; D015742:Propofol