Topical Pharyngeal Anesthesia Research Articles

Topical pharyngeal anesthesia with articaine for gastroscopy: a double-blinded, randomized cross-over study in healthy volunteers

Objectives The benefits of topical pharyngeal anesthesia for gastroscopy remain under debate. Articaine, a local anesthetic with fast onset and offset of action as well as low systemic toxicity, could be a promising choice for topical anesthesia. The objective of this study was to assess whether topical pharyngeal anesthesia with articaine is beneficial in sedated gastroscopy. Materials and methods This randomized double-blinded cross-over study included nine volunteers who underwent two gastroscopies under conscious sedation. One was performed with topical pharyngeal anesthesia with articaine and the other with placebo. Hemodynamic parameters including autonomic nervous system state were recorded prior to and during the endoscopic procedure. The endoscopist and the volunteer assessed the endoscopy after the examination. Results Topical pharyngeal anesthesia with articaine resulted in less discomfort during esophageal intubation and higher patient satisfaction with the procedure. Topical pharyngeal anesthesia with articaine did not increase satisfaction or facilitate the procedure as rated by the endoscopist. There were no clinically relevant differences in hemodynamic parameters. Conclusion The use of articaine for topical pharyngeal anesthesia results in less intubation-related discomfort and better satisfaction.

Effect of Premedication with Glycopyrrolate on Patient Tolerance and Procedure Outcomes in Patients Undergoing Unsedated Upper Gastrointestinal Endoscopy: A Randomized Placebo-controlled Trial.

An optimal topical pharyngeal anesthesia (TPA) is required for better patient tolerance and procedural outcomes of an unsedated upper gastrointestinal endoscopy (UGIE). Several additional strategies have been tried to improve patient tolerance with limited success. We hypothesized that premedication with glycopyrrolate would enhance TPA and improve patient tolerance and procedural outcomes of an unsedated UGIE. We conducted a randomized, double-blind, placebo-controlled trial between July 2020 and May 2022. Consecutive patients undergoing unsedated UGIE were randomly assigned to receive either intravenous glycopyrrolate or a placebo 30 minutes before TPA. Patient tolerance, comfort level for the endoscopist, cardiorespiratory fluctuations, percentage of failed esophageal intubation, and incomplete examination were studied. 380 patients were randomized to 190 in each arm. The median (IQR) VAS scores for the overall patient satisfaction in the glycopyrrolate and placebo groups were 8 (1) and 7 (2), respectively (p = 0.04). The median (IQR) VAS scores for endoscopist assessment of patient cooperation in the glycopyrrolate and placebo groups were 8 (1.3) and 8 (1), respectively (p = 0.04). There was no difference in the percentage of failed esophageal intubation and incomplete examination, fluctuations in heart rate, and oxygen saturation of the participants. However, the mean arterial pressure (MAP) on-table before the start of the procedure at 1 minute and 3 minutes was significantly higher in the glycopyrrolate group (p = 0.01, 0.01, and 0.04, respectively). In unsedated UGIE, glycopyrrolate premedication significantly improves the patient tolerance and endoscopist's comfort, with minimal cardiorespiratory effects. Hence, it could be incorporated into day-care unsedated endoscopy practice.Trial registration - CTRI/2020/07/026786. Ramalingam R, Senthamizhselvan K, Harichandrakumar KT, et al. Effect of Premedication with Glycopyrrolate on Patient Tolerance and Procedure Outcomes in Patients Undergoing Unsedated Upper Gastrointestinal Endoscopy: A Randomized Placebo-controlled Trial. Euroasian J Hepato-Gastroenterol 2023;13(2):55-60.

Five Versus 10 Pharyngeal Sprays of 10% Lignocaine for Topical Anesthesia During Flexible Bronchoscopy: A Multicenter, Randomized Controlled Trial.

Ensuring adequate patient comfort is crucial during bronchoscopy. Although lidocaine spray is recommended for topical pharyngeal anesthesia, the optimum dose of sprays is unclear. We compared 5 versus 10 sprays of 10% lidocaine for topical anesthesia during bronchoscopy. In this investigator-initiated, prospective, multicenter, randomized clinical trial, subjects were randomized to receive 5 (group A) or 10 sprays (group B) of 10% lidocaine. The primary objective was to compare the operator-rated overall procedure satisfaction between the groups. Two hundred eighty-four subjects were randomized (143 group A and 141 group B). The operator-rated overall procedure satisfaction, VAS [mean (SD)] was similar between the groups [group A, 74.1 (19.9) and group B, 74.3 (18.5), P=0.93]. The VAS scores of patient-rated cough [group A, 32.5 (22.9) and group B, 32.3 (22.2), P=0.93], and operator-rated cough [group A, 29.8 (22.3) and group B, 26.9 (21.5), P=0.26] were also similar. The time to reach vocal cords, overall procedure duration, mean doses of sedatives, the proportion of subjects willing to return for a repeat procedure (if required), and complications were not significantly different. Subjects in group A received significantly less cumulative lidocaine (mg) [group A, 293.9 (11.6) and group B, 343.5 (10.6), P<0.001]. During bronchoscopy, topical anesthesia with 5 sprays of 10% lidocaine is preferred as it is associated with a similar operator-rated overall procedure satisfaction at a lower cumulative lidocaine dose compared with 10 sprays.

Hard-Candy Consumption Does Not Have an Effect on Volume and pH of Gastric Content in Patients Undergoing Elective Gastrointestinal Endoscopic Procedures: A Randomized Controlled Trial.

This study aimed to determine the effect of hard candies on gastric content volume and pH in patients undergoing elective esophagogastroduodenoscopy and colonoscopy. Additionally, the study evaluated the difficulty of the procedure, complications, and satisfaction levels of the endoscopist and patient. A randomized controlled study equally recruited 108 outpatients to candy and control groups. The patients in the candy group could consume sugar-free candies within 2 hours before anesthesia, while the controls remained fasted. The endoscopic procedure began under topical pharyngeal anesthesia and intravenous sedation. A blinded endoscopist suctioned the gastric volume through an endoscope. A blinded anesthesia provider tested the gastric pH with a pH meter. The primary outcome variables were gastric volume and pH. The secondary outcome variables were complications, the difficulty of the procedure, and endoscopist and patient satisfaction. The characteristics of both patient groups were comparable. The mean gastric volume of the candy group (0.43 [0.27-0.67] mL/kg) was not significantly different from that of the control group (0.32 [0.19-0.55] mL/kg). The gastric pH of both groups was similar: 1.40 (1.10-1.70) for the candy group and 1.40 (1.20-1.90) for the control group. The procedure-difficulty score of the candy group was higher than that of the control group. The satisfaction scores rated by the endoscopist and the patients in both groups were comparable. In addition, most endoscopists and patients in the candy and control groups reported being "very satisfied". No complications were observed in either group. Hard candies did not affect gastric volume or pH. Elective gastrointestinal endoscopic procedures in adult patients who preoperatively consume candies could proceed to prevent delays and disruption of workflows.

Topical Pharyngeal Anesthesia and Upper Endoscopy (MEDLINE).

Abstract What is the impact of topical pharyngeal anesthesia on patient tolerance, procedural duration, sedation requirements, and adverse events during upper endoscopy?

Evaluation of pharyngeal lidocaine anesthesia for esophagogastroduodenoscopy: Double-blind randomized control trial.

The aim of this study was to assess whether the use of topical pharyngeal anesthesia improves endoscopist- and patient-reported tolerance and satisfaction, the total dose of propofol used and the rate of adverse effects associated with this procedure. This double-blind randomized clinical trial was conducted in patients undergoing elective oesophagogastroduodenoscopy, who met the inclusion criteria. Patients were randomly assigned to receive five squirts of lidocaine 10% spray (50 mg, n = 268) or placebo (n = 271) 3 min before starting the procedure or sedation. The main outcome measures were patient- and endoscopist-reported tolerance, and additionally, satisfaction with the procedure, adverse events and supplementary propofol used. In the lidocaine group, it was twice (odds ratio [OR] 2.136, 95% confidence interval [CI] 1.228-3.715) or three times (OR 3.311, 95% CI 1.623-6.757) more likely that the endoscopist rated the procedure as well tolerated and easy to intubate than as well tolerated but the patient difficult to intubate or as poorly tolerated, respectively. Further, in these patients, less propofol was used (80 vs. 100 mg, P = 0.001). Controls were more likely to cough during the intubation (OR 2.172, 95% CI 1.378-3.423) and the procedure (OR 1.989, 95% CI 1.325-2.984), as well as more likely to retch (OR 3.582, 95% CI 1.667-7.7). Topical lidocaine may improve the procedure as rated by the endoscopist, as well as reduce the requirement for propofol and rate of adverse events such as retching and coughing. No adverse events associated with lidocaine administration were observed. ClinicalTrials registration no. NCT02733471.

Comparative effectiveness of lidocaine sprays between sitting and supine position for patients undergoing upper gastrointestinal endoscopy: a prospective randomized controlled trial.

Topical pharyngeal anesthesia has improved esophagogastroduodenoscopy (EGD) efficiency with smooth insertion, reducing pain and discomfort. Lidocaine spray is one of the safe and widely used methods. In practice, the patients walk, sit in a wheelchair, or lie on a trolley bed, and the lidocaine sprays are applied to those in sitting or supine positions for pre-endoscopic preparation. Although there is no current guidance technique, this study aims to compare the effects of lidocaine sprays between sitting (Group A; Gp A) and supine positions (Group B; Gp B) for patients undergoing unsedated EGD. This study was a single-center prospective randomized controlled trial. Unsedated EGD patients were randomly allocated the lidocaine spray in sitting or lidocaine spray in the supine position. Lidocaine spray treatments were significantly different in the gag reflex (NRS; Gp A: 1.28 ± 0.67, Gp B: 1 ± 0.63, p = 0.0003), ease of esophageal instrumentation (NRS; Gp A: 7.68 ± 0.91, Gp B: 7.95 ± 0.66, p = 0.0042), and pain score (NRS; Gp A: 5.16 ± 2.08, Gp B: 4.53 ± 1.93, p = 0.0059). When considering modified Mallampati classification (MMC), MMC classes III and IV were significantly different in the same direction but MMC classes I and II were not. The technique of spraying in the supine position was associated with less gagging, less pain, and easier esophageal instrumentation, especially in patients with MMC classes III and IV.

Study of ideal topical pharyngeal anesthesia in upper gastrointestinal system endoscopy: A double-blind, randomized, controlled trial.

This study is designed to determine which drug forms provide ideal pharyngeal anesthesia when used during upper gastrointestinal system endoscopy. A total of 180 patients were included in the study. Using the random number table, these patients were divided into three groups. Group 1, lidocaine gel+isotonic spray; Group 2, base lubricant gel+lidocaine spray; and Group 3: lidocaine gel+lidocaine spray. Data were collected from the patient identification form, compliance to operation form, and State Anxiety Inventory. Anesthetization and compliance to procedure scores were higher and anxiety scores were lower in Group 3 than in other groups (p<0.05). It was observed that as the compliance score increased, the anesthetization and satisfaction scores also increased; however, coughing during the procedure, duration of the procedure, and anxiety scores decreased (p<0.05). It was determined that as anesthetization scores increased, discomfort in the throat caused by the device, coughing during the procedure, and anxiety scores decreased (p<0.05). Lidocaine gel and spray combination is the most ideal pharyngeal anesthesia to ensure the adaptation of the patient to the procedure and to decrease anxiety and discomfort during the procedure.

P5. Virtual lesion model to investigate dysphagia resulting from pharyngeal hypesthesia in healthy volunteers

Objective Dysphagia is a frequent and outcome-relevant complication of various neurological disorders, whose treatment options are still limited. Lately, neuromodulatory treatment devices have come into focus to enhance adaptive plasticity in the cortical swallowing network. However, performing neurophysiological and functional imaging studies to investigate these novel neurostimulation techniques for the treatment of neurogenic dysphagia in severely affected patients is difficult. Therefore, basic research needs to be conducted in healthy subjects instead. Here, we propose a virtual peripheral sensory lesion model to mimic pharyngeal sensory impairment, which is known to be a major contributor to dysphagia in neurological disease, as swallowing is a motor function highly dependent on sensory afferent input. Methods In this randomized crossover study on 11 healthy volunteers, cortical activation during pneumatic pharyngeal stimulation was measured applying 275-channel magnetoencephalography (MEG) in two separate sessions, with and without pharyngeal surface anesthesia. Individual source reconstruction was performed applying a linear constraint minimum variance (LCMV-) beamformer algorithm and significant differences between conditions were assessed with a nonparametric permutation test. Results Pneumatic pharyngeal stimulation evoked bilateral event-related desynchronization (ERD) mainly in the primary and secondary sensorimotor areas located in the caudolateral pericentral cortex, the insula, the prefrontal cortex and the supramarginal gyrus. In comparison to the no-anesthesia condition, topical pharyngeal anesthesia led to a virtual lesion in this network, indicated by a reduction of ERD in beta (13–30 Hz) and low gamma (30–60 Hz) frequency ranges (p Conclusions Withdrawal of sensory afferent information by topical surface anesthesia leads to reduced response to pneumatic pharyngeal stimulation in a distributed cortical sensorimotor network in healthy subjects thereby mimicking the situation in patients with dysphagia related to sensory impairment. Significance The proposed virtual sensory lesion paradigm may serve to investigate the effect of neuromodulatory treatments specifically on pharyngeal sensory impairment as relevant cause of neurogenic dysphagia.

Topical pharyngeal anesthesia provides no additional benefit to propofol sedation for esophagogastroduodenoscopy: a randomized controlled double-blinded clinical trial

Propofol sedation has been applied during esophagogastroduodenoscopy procedures, but whether topical pharyngeal anesthesia should be administered at the same time has rarely been reported. Our study examined the role of topical pharyngeal anesthesia in sedated endoscopies in a randomized controlled double-blinded clinical trial. A total of 626 patients who underwent sedated esophagogastroduodenoscopy were randomized into the experimental group (n = 313) or the control group (n = 313). The discomfort score, immediately and one day after the procedure, was not statistically significant [7.2 (5–9) vs. 7.5 (6–9), P = 0.210; 2.3 (0–3) vs. 2.6 (0–4), P = 0.095, respectively]. Two patients in the experimental group and three patients in the control group needed oral medication for pharyngeal discomfort (P = 0.354). The satisfaction score was 9.2 (8–10) in the experimental group and 8.9 (7–10) in the control group (P = 0.778). Lidocaine topical pharyngeal anesthesia in propofol-sedated esophagogastroduodenoscopy did not further reduce the pharyngeal discomfort or improve the satisfaction. This clinical trial was registered at ClinicalTrials.gov (ClinicalTrials.gov ID: NCT03070379).

Endoscopic management of foreign bodies in the upper gastrointestinal tract: a retrospective study of 1294 cases

Objective: To report our endoscopic outcomes and explore the effects of duration of impaction and anesthetic methods on the endoscopic removal of foreign bodies in the upper gastrointestinal tract.Methods: All consecutive patients with suspected foreign body (FB) ingestion between January 2013 and June 2016 were enrolled. Demographic, clinical and endoscopic data were collected and analyzed.Results: A total of 1294 patients aged seven months to 94 years were enrolled. Odynophagia (415 cases, 32.1%), FB sensation (340 cases, 26.3%) and sore throat (267 cases, 20.1%) were the most frequent complaints. The duration of FB impaction ranged from 4 h to over two years. Anatomically, foreign bodies were most commonly located in the esophagus (n = 1025, 86.9%). Bony foreign bodies comprised the majority of identified foreign bodies. The most common underlying pathology was esophageal stricture (38 cases, 53.5%). Nearly half of the patients (49.9%) developed complications. As the duration of impaction increased, the success rate by endoscopy decreased (p < .001), and the complication rate increased (p < .001). Endoscopic management under general anesthesia didn’t improve the success rate or lower the complication rate compared with topical pharyngeal anesthesia (p = .793 and p = .085). Age ≥60, duration of impaction longer than one day, impaction in the esophagus, and sharp foreign bodies were identified as risk factors for complications.Conclusions: Delayed flexible endoscopy in patients, especially elderly patients, with sharp FB impactions in the esophagus results in worse endoscopic outcomes. Endoscopic management under general anesthesia did not improve the therapeutic results compared with topical pharyngeal anesthesia.

Impact of Topical Pharyngeal Anesthetics on Recovery of Patients when Used with Propofol Sedation for Routine EGDs

Introduction: Topical pharyngeal anesthetics when used in conjunction with intravenous sedatives during esophagogastroduodenoscopy (EGD) may ease the endoscopy by diminishing the gag reflex and decreasing patient discomfort. Studies have supported the use of topical pharyngeal anesthetics with sedatives such as benzodiazepines and opiates. However the added benefit of topical pharyngeal anesthetics in combination with propofol is questionable. Topical anesthetics can cause serious adverse effects including aspiration, methemoglobinemia and anaphylaxis. Our ongoing prospective study is aimed to determine if topical pharyngeal lidocaine application with propofol sedation during EGDs affects the recovery time of the patient. Methods: In this prospective, double blind single center trial, eligible, consented patients undergoing elective EGD were randomized to gargle and swallow either 7.5 ml of 2% lidocaine viscous solution or placebo 5 min prior to the administration of IV propofol. After the procedure, patients were monitored in the recovery room. Time from when the patient was taken into the recovery room to discharge was recorded. Total procedure time, physician satisfaction, patient discomfort (VAS), amount of propofol administered, and adverse events in both groups were the other variables recorded. Differences between treatment groups on continuous variables were tested using the Wilcoxon Rank Sum test. Results: 73 subjects (31 males and 42 females) are included in this interim analysis, with 36 subjects in the lidocaine group and 37 subjects in the placebo group. There were no statistically significant differences between the lidocaine and placebo groups with respect to recovery time, procedure time, physician satisfaction, patient discomfort, amount of propofol administered or number of times the patient gagged during the procedure. Pain scores of 0 were reported by all subjects at both the first and last recordings in recovery. All except one patient were intubated in first attempt. One patient required two attempts for esophageal intubation. There were 3 adverse events noted, 1 in the lidocaine group and 2 in the placebo group. These events were described as vomiting, coughing and desaturation. Conclusion: Our interim analysis does not suggest that topical pharyngeal anesthetics influence recovery when used with propofol. However propofol is a highly potent excellent sedative and there is no added advantage of topical pharyngeal anesthesia during EGDs under propofol sedation.Table 1Figure 1

Topical Pharyngeal Anesthesia for Unsedated Esophagogastroduodenoscopy Procedure in Sick Patients

The aim of this study was to evaluate and compare the clinical efficacy of topical pharyngeal anesthesia for unsedated esophagogastroduodenoscopy (UEGD) procedure in sick (American Society of Anesthesiologists [ASA] physical status III-IV) and nonsick (ASA physical status I-II) patients in a teaching hospital in Thailand. We undertook a retrospective review of the anesthesia or sedation service records of adult patients who underwent UEGD procedures from October 2008 to September 2009. All patients were classified into two groups according to the ASA physical status. In group A, the patients had ASA physical status I-II, while in group B, the patients had ASA physical status III-IV. The primary outcome variable of the study was the successful completion of the procedure. The secondary outcome variables were anesthesia and procedure-related adverse events during and immediately after the procedure. After matching age, gender, weight, height and duration of procedure, there were 566 adult patients who underwent UEGD procedures by using topical pharyngeal anesthesia. Of these, 287 patients were in group A and 279 patients were in group B. There were no significant differences in age, gender, weight, height and duration of UEGD procedure between the two groups. All patients in both groups successfully completed the procedure except four patients in group A, and one patient in group B (P=0.188). Anesthesia and procedure-related adverse events in both groups were not significantly different. All adverse events were transient and mild degree with no adverse sequelae. Topical pharyngeal anesthesia for UEGD procedure in sick patients by trained anesthetic personnel with appropriate monitoring was safe and effective. The clinical efficacy of this technique in sick patients was not different or worse than in nonsick patients. Serious adverse events were rare in our population.

The effect of sedation during transoesophageal echocardiography on heart rate variability: a comparison of hypnotic sedation with medical sedation

There is no ideal sedation technique that can be used during transoesophageal echocardiography (TEE), and the data concerning the effects of available sedation techniques on heart rate variability (HRV) are limited. To compare the effects of sedation through hypnotherapy with medical sedation achieved by midazolam on HRV. We recruited 76 patients with an indication of TEE; the age range was 18-83 years. In Group T there were 26 patients who had the procedure under topical pharyngeal anaesthesia, in Group D there were 23 patients who received midazolam, and in Group H there were 27 patients receiving hypnosis. All patients had an IV access; throughout the procedure heart rate, rhythm electrocardiography, and peripheric O2 saturation were monitored with a non-invasive monitor, and blood pressure measurements were taken every 3 min. Rhythm Holter recordings were obtained from all patients and TEE was performed. When time domain parameters for HRV were compared in all three groups, the hypnosis group had significant increases in pNN50 and RMSSD compared to Groups D and T (p < 0.05). As concerns frequency domain parameters, there were no significant differences between groups where low frequency (LF) was decreased in hypnosis group and high frequency (HF) was increased (p > 0.05). However, LF/HF was decreased statistically significantly (p < 0.05) when compared with the midazolam group. Contrary to standard sedation in TEE patients, when hypnosis is used autonomic cardiac tone is modified to a significant extent. Hypnotic sedation achieves this by increasing the parasympathetic activity, decreasing the sympathetic activity, and changing the sympathovagal interaction balance.

Unsedated Esophagogastroduodenoscopy in Cirrhotic Patients: An Impact of Topical Pharyngeal Anesthesia

Topical pharyngeal anesthesia is generally used as pretreatment for unsedated esophagogastroduodenoscopy (UEGD). The effectiveness of topical pharyngeal anesthesia for UEGD in cirrhotic patients has been limited reports in the medical literature. The study is aimed to study the impact of topical pharyngeal anesthesia for UEGD procedure in cirrhotic patients in the World Gastroenterology Organization Endoscopy Training Center in Thailand. Retrospectively analyzed the patients on whom UEGD procedures had been performed during the period of December, 2007 to May, 2009 in Siriraj Hospital. The patients’ characteristics, duration of procedure, preanesthetic problems and anesthesia-related adverse events were assessed. The primary outcome variable of the study was the successful completion of the procedure. The secondary outcome variables were anesthesia-related adverse events and the alteration of hemodynamic parameters. During the study period, there were 346 cirrhotic patients who underwent UEGD procedure. All UEGD procedures were succeeded except four cases. The mean age of the patients was 55.9±11.9 years, and most were American Society of Anesthesiologists (ASA) class II (53.2%). The mean duration of procedure was 13.5±7.4 minutes. Topical pharyngeal anesthesia for UEGD procedure in the cirrhotic patients is relatively safe and effective. Anesthesiarelated adverse events in the cirrhotic patients were relatively high. However, these adverse events were mild, transient, without specific interventions, with no adverse sequelae.

Su1513 Lidocaine Sprayed-on the Endoscope Can Improve the Tolerance During Upper Gastrointestinal Endoscopy?

Topical pharyngeal anesthesia has been the standard preparation for reducing the discomfort during upper gastrointestinal endoscopy (UGIE). But it is not clear whether this method effective in regard to the tolerance of procedure. The aim of this study is to assess the efficacies of the added lidocaine spray on the tip of endoscope in improving patient tolerance.

Anesthesia-Related Adverse Event Rate and Alteration of Blood Pressure and Heart Rate During and Immediately after Unsedated Esophagogastroduodenoscopy in Elderly Patients

AIMS: Esophagogastroduodenoscopy (EGD) is safely performed by using topical pharyngeal anesthesia in elderly patients. However, it can induce hemodynamic changes and adverse events. The aim of this study was to compare and evaluate the anesthesia-related adverse event rate and the alteration of blood pressure and heart rate in unsedated EGD procedure between elderly patients and younger patients. METHODS: 1,998 patients underwent unsedated EGD procedures in the study period. All patients who had no history of hypertension, diabetes and cardiovascular diseases were categorized into the two groups. Patients aged <65 years were in group A, and patients aged ≥65 years were in group B. The primary outcome variable was the anesthesia-related adverse event rate during and immediately after the procedure. The secondary outcome variables were the alteration of blood pressure and heart rate. RESULTS: After matching gender, weight, ASA physical status and indications of procedure, there were 342 patients in group A and 195 patients in group B. All endoscopies were completely successfully. There were no significant differences in gender, weight, ASA physical status, duration of procedure, indication of endoscopy, hemodynamic parameters, and the anesthesia-related adverse events between the two groups. All adverse events were mild degree, transient and did not require medications. CONCLUSION: Anesthesia-related adverse event rate and alterations of blood pressure and heart rate during and immediately after unsedated EGD procedure in the elderly patients are relatively high. However, all of these are mild, transient and did not greater than in the younger patients.

Influence of pharyngeal muscle activity on inspiratory negative effort dependence in the human upper airway

The upper airway is often modeled as a Starling resistor, which predicts that flow is independent of inspiratory effort during flow limitation. However, while some obstructive sleep apnea (OSA) patients exhibit flat, Starling resistor-like flow limitation, others demonstrate considerable negative effort dependence (NED), defined as the percent reduction in flow from peak to mid-inspiration. We hypothesized that the variability in NED could be due to differences in phasic pharyngeal muscle activation between individuals. Therefore, we induced topical pharyngeal anesthesia to reduce phasic pharyngeal muscle activation to see if it increased NED.Twelve subjects aged 50±10 years with a BMI of 35±6kg/m2 and severe OSA (apnea-hypopnea index=52±28 events/h) were studied. NED and phasic genioglossus muscle activity (EMGGG) of flow limited breaths were determined before and after pharyngeal anesthesia with lidocaine. Pharyngeal anesthesia led to a 33% reduction in EMGGG activity (p<0.001), but NED worsened only by 3.6±5.8% (p=0.056).In conclusion, phasic EMGGG had little effect on NED. This finding suggests that individual differences in phasic EMGGG activation do not likely explain the variability in NED found among OSA patients.

Lidocaine lozenges for pharyngeal anesthesia during upper gastrointestinal endoscopy: A randomized controlled trial

Abstract Background and Objectives: A novel lozenge formulation with advantages of ease of drug administration, palatable taste and improved patient compliance could be the preferred mode of topical pharyngeal anesthesia during upper gastrointestinal endoscopy (UGE). This randomized, open-label, active-controlled study was conducted to evaluate the efficacy and safety of lidocaine lozenges versus lidocaine spray in the diagnostic gastroduodenal endoscopy in Indian patients. Subjects and Methods: Two hundred and forty-seven patients of either sex (18-80 years) undergoing diagnostic gastroduodenal endoscopy were randomized either to; lidocaine lozenge 200 mg or lidocaine spray 200 mg to be applied as a single dose before gastroduodenal endoscopy. Ease of procedure, level of gag reflex, ease of application of the local anesthetic, and investigators global assessment were the primary efficacy endpoints. Need for rescue medication and patient’s global assessment were secondary efficacy endpoints. The incidence of any adverse event was the safety endpoint. Between groups, comparison was done by using appropriate statistical test. Results: Investigator reported significantly lesser procedural difficulty (P = 0.0007) and suppressed gag reflex (P &lt; 0.0001) during UGE with lidocaine lozenge compared to spray. Ease of application of local anesthetic was reported easy in significantly more patients as compared with lidocaine spray (P = 0.001). Global assessment by patient and physician was favorable toward lozenge. Incidences of adverse events were similar in both the groups. Conclusions: The study suggests that lidocaine lozenges are an easier way of applying local oropharyngeal anesthesia, produces better suppression of gag reflex and makes the procedure easier when compared with lidocaine spray.

Propofol deep sedation with or without topical pharyngeal anesthesia for endoscopic ultrasonography procedure in elderly patients

Propofol deep sedation with or without topical pharyngeal anesthesia for endoscopic ultrasonography procedure in elderly patients