Is topical pharyngeal anesthesia necessary for patients undergoing upper endoscopy with adequate level of conscious sedation - A multi center randomized double blind placebo controlled study

R. K. Hsu, E. R. Pecha, M. Hosseini, K. Man, T. Desta, J. G. Lee, K. Lam, Joseph Leung

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Introduction: The practice of premedication in upper endoscopy varies. Topical anesthesia is used alone in some countries whereas conscious sedation together with topical anesthesia are used in the U.S. This study compares the outcome of three common pharyngeal anesthesia on patients' tolerance and the ease of examination in upper endoscopy with conscious sedation. Method: Patients undergoing diagnostic upper endoscopy with conscious sedation using midazolam and fentanyl were recruited. They were randomized to receive one of four pharyngeal sprays - Xylocaine 10%, Hurricaine, Cetacaine and placebo. Five sprays were applied at a standard level of sedation - drowsy-heavy eyelids and slurred speech. The scores of endoscopists' observation on the ease examination and patients' recall and satisfaction were analyzed using Kruskal Wallis one way ANOVA by ranks. Results: mean score spray a spray b spray c spray d p n=18 n=15 n=17 n=15 value ease of intubation 1.7 1.5 1.9 1.7 0.52 mucosal visualization 1.2 1.3 1.2 1.3 0.73 no. of gags 2.3 1.0 2.7 4.0 0.04* level of amnesia 2.1 2.1 1.9 2.2 0.91 discomfort during intubation 1.6 1.6 1.7 1.3 0.37 throat discomfort after exam 1.6 1.7 1.4 1.5 0.66 taste 2.1 1.4 1.9 1.7 0.09* Key: a-Hurricaine 20% benzocaine; b-Xylocaine 10%; c-placebo; d-Cetacaine 14% benzocaine. The number of gags using Cetacaine and control were significantly more than Xylocaine. The taste of Hurricaine is less well tolerated than Xylocaine. There was no difference in the ease of intubation, mucosal visualization; patients' recall of discomfort, tolerance, throat discomfort after exam. Conclusion: In simple outpatient diagnostic endoscopy, topical pharyngeal spray does not appear to affect the patients' satisfaction except for taste when adequate level of sedation is achieved.

Original languageEnglish (US)
JournalGastrointestinal Endoscopy
Issue number4
StatePublished - 1997


ASJC Scopus subject areas

  • Gastroenterology

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