title: Sedation-associated hiccups in adults undergoing gastrointestinal endoscopy and colonoscopy.
abstract: OBJECTIVE
  To investigate whether the incidence of hiccups in patients undergoing esophagogastroduodenoscopy (EGD) or same-day bidirectional endoscopy (EGD and colonoscopy; BDE) with sedation is different from those without sedation in terms of quantity, duration and typical onset time.
  
  
  METHODS
  Consecutive patients scheduled for elective EGD or same-day BDE at the gastrointestinal endoscopy unit or the health examination center were allocated to two groups: EGD without sedation (Group A) and BDE with sedation (Group B). The use of sedation was based on the patients' request. Anesthesiologists participated in this study by administrating sedative drugs as usual. A single experienced gastroenterologist performed both the EGD and the colonoscopic examinations for all the patients. The incidence, duration and onset time of hiccups were measured in both groups. In addition, the association between clinical variables and hiccups were analyzed.
  
  
  RESULTS
  A total of 435 patients were enrolled in the study. The incidences of hiccups in the patients with and without sedation were significantly different (20.5% and 5.1%, respectively). The use of sedation for patients undergoing endoscopy was still significantly associated with an increased risk of hiccups (adjusted odds ratio: 8.79, P < 0.001) after adjustment. The incidence of hiccups in males under sedation was high (67.4%). The sedated patients who received 2 mg midazolam developed hiccups more frequently compared to those receiving 1 mg midazolam (P = 0.0028). The patients with the diagnosis of gastroesophageal reflux disease (GERD) were prone to develop hiccups (P = 0.018).
  
  
  CONCLUSIONS
  Male patients undergoing EGD or BDE with sedation are significantly more likely to suffer from hiccups compared to those without sedation. Midazolam was significantly associated with an increased risk of hiccups. Furthermore, patients with GERD are prone to develop hiccups.
authors: Department of Anesthesiology, E-DA Hospital, I-Shou University, Kaohsiung 82445, Taiwan, China.
authors: Chien Cheng
authors: CC
authors: Liu
authors: Cheng Yuan
authors: CY
authors: Lu
authors: Chih Fang
authors: CF
authors: Changchien
authors: Ping Hsin
authors: PH
authors: Liu
authors: Daw Shyong
authors: DS
authors: Perng
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003113:Colonoscopy / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D006606:Hiccup / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam