Department of Anesthesiology, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Kuei Shan Hsiang, Taoyuan 333, Taiwan.
Dig Dis Sci. 2012 Oct;57(10):2519-26. doi: 10.1007/s10620-012-2206-4. Epub 2012 May 6.
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.
To demonstrate the limited value of topical pharyngeal anesthesia in patients under moderate to deep sedation with propofol.
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.
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.
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.
在静脉镇静的基础上联合应用咽部表面麻醉以辅助胃镜检查已得到广泛认可；然而，在接受异丙酚深度镇静的患者中，其效果尚未得到证实。
证明在接受异丙酚中至深度镇静的患者中，咽部表面麻醉的作用有限。
将 129 例行胃镜检查的患者前瞻性随机分为两组，分别在静脉推注异丙酚的基础上联合应用 10%利多卡因或蒸馏水咽部喷雾。麻醉医生和胃肠病医生评估患者的言语和躯体反应、咽反射和呃逆的存在、食管插管的整体难易程度。比较两组患者在 5 个时间点的血流动力学参数，包括外周血氧饱和度、收缩压/舒张压（SBP/DBP）、心率（HR）、双频谱指数（BIS）和 SBP×HR，时间点分别为到达时、自主呼吸 5 次后、异丙酚估计脑浓度 Ce 达到 3.5μg/ml 时、食管插管时和苏醒时。
利多卡因组和蒸馏水组在言语或躯体反应、食管插管时的咽反射或呃逆方面无统计学差异。同样，BIS、SBP、DBP 和 HR 在两组之间也无显著差异。
在进行诊断性胃镜检查时，联合应用异丙酚靶控输注和咽部表面麻醉可能会被淘汰，而不会对患者的护理或结局产生不利影响。
