Evans Luke T, Saberi Sara, Kim Hyungjin Myra, Elta Grace H, Schoenfeld Philip
Division of Gastroenterology, University of Michigan School of Medicine, Ann Arbor, Michigan 48105, USA.
Gastrointest Endosc. 2006 May;63(6):761-6. doi: 10.1016/j.gie.2005.11.059.
Pharyngeal anesthesia is widely used as an adjunct to sedation during upper endoscopy. Methemoglobinemia and anaphylactic reactions are rare but serious complications of topical anesthetic agents. Individual studies produce variable results about the effectiveness of pharyngeal anesthesia in improving patient tolerance.
A systematic review was performed to evaluate the effectiveness of pharyngeal anesthesia in improving patient tolerance and ease of endoscopy during sedated upper endoscopy.
A MEDLINE search, an EMBASE search, and manual searches were performed to identify pertinent English language articles. Randomized controlled trials (RCT) comparing the efficacy of pharyngeal anesthesia to placebo or no treatment were identified. Duplicate data extraction about patient tolerance of the procedure and endoscopist assessment regarding the ease of endoscopy was performed.
From a pool of 53 studies, 5 RCTs evaluated a total of 491 patients and provided interpretable data. Patients who rated their discomfort during the sedated procedure as none/minimal were more likely to have received pharyngeal anesthesia (odds ratio [OR] 1.88, 95% confidence interval [CI] 1.13-3.12). Endoscopists were more likely to rate the procedure as "not difficult" for patients who received pharyngeal anesthesia (OR 2.60, 95% CI 1.63-4.17).
Lack of standardized outcome measurements and standardized sedation strategies led to heterogeneity in the patient-tolerance portion of the meta-analysis.
Pharyngeal anesthesia before upper endoscopy improves ease of endoscopy and also improves patient tolerance.
咽部麻醉作为上消化道内镜检查期间镇静的辅助手段被广泛应用。高铁血红蛋白血症和过敏反应是局部麻醉剂罕见但严重的并发症。关于咽部麻醉在提高患者耐受性方面的有效性，个别研究得出了不同的结果。
进行一项系统评价，以评估咽部麻醉在提高镇静状态下上消化道内镜检查时患者耐受性及内镜操作便利性方面的有效性。
通过检索医学文献数据库（MEDLINE）、荷兰医学文摘数据库（EMBASE）以及手工检索来识别相关的英文文章。纳入比较咽部麻醉与安慰剂或不治疗疗效的随机对照试验（RCT）。对有关患者对操作的耐受性以及内镜医师对内镜操作便利性评估的重复数据进行提取。
从53项研究中，5项RCT共评估了491例患者并提供了可解释的数据。在镇静操作过程中，将不适程度评为无/轻微的患者更有可能接受了咽部麻醉（优势比[OR]为1.88，95%置信区间[CI]为1.13 - 3.12）。对于接受咽部麻醉的患者，内镜医师更有可能将操作评为“不难”（OR为2.60，95%CI为1.63 - 4.17）。
缺乏标准化的结局测量和标准化的镇静策略导致了荟萃分析中患者耐受性部分的异质性。
上消化道内镜检查前进行咽部麻醉可提高内镜操作的便利性，同时也能提高患者的耐受性。
