From rxpgnews.com
Patients may have sweet and effective way to prepare for upper GI endoscopy: an anesthetic lollipop
By American Society for Gastrointestinal Endoscopy,
Oct 16, 2007 - 3:59:37 AM
OAK BROOK, Ill. � October 16, 2007 � Researchers at the American University of Beirut Medical Center (AUBMC) in Lebanon have found that administering a lidocaine lollipop as a single-agent anesthetic to patients undergoing an upper gastrointestinal (GI) endoscopy procedure eliminated the need for sedation in the majority of patients. The research appears in the October issue of Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy.
Upper endoscopy allows physicians to examine the lining of the upper part of the GI tract, which includes the esophagus, stomach and duodenum (first portion of the small intestine). It is often done under sedation to assure patient comfort. Upper endoscopy helps physicians evaluate symptoms of persistent upper abdominal pain, nausea, vomiting, or difficulty swallowing. It is the best test for finding the cause of bleeding from the upper GI tract and is also more accurate than X-rays for detecting inflammation, ulcers, and tumors of the esophagus, stomach, and duodenum.
�A significant portion of the complications, as well as the cost, of upper gastrointestinal endoscopy are often attributed to conscious intravenous sedation. In this study, we compared the efficacy of topical lidocaine administered in the form of a lollipop as a single-agent anesthetic with the conventional lidocaine spray, and determined whether it decreased the need for or the amount of intravenous sedation,� said study lead author Assaad Soweid, MD, FASGE, American University of Beirut Medical Center. �We found that 32 percent of the patients given the lidocaine lollipop required intravenous sedation compared with 96 percent of the patients who received the spray. The lollipop proved to be a safe and well-tolerated topical anesthetic. It is quite promising and may be particularly important for use with the elderly, patients who have comorbidities and in office-based endoscopy.�
Lollipops have been successfully used to provide anesthesia to children before painful procedures. The concept of using a lidocaine lollipop as a single-agent anesthetic in upper endoscopy is novel and has not been reported in medical literature. Medications to achieve sedation, however, may cause potential side effects such as respiratory depression, hypotension (low blood pressure) and paradoxical agitation, in which the patient becomes agitated rather than sleepy from the sedation. These side effects happen more so in elderly patients and those with comorbid illnesses.
The lollipop used in this study was developed by the anesthesia department in collaboration with the pharmacy department at AUBMC. Fifty grams of white sugar were heated until liquefied; an equal amount of golden maple syrup was slowly added. For each lollipop, 3 mL of this mixture were poured into a small cylindric container, to which 300 mg of lidocaine hydrochloride salt was added and stirred. As the the mixture cooled and solidified, a small plastic stick was plunged at one end for holding the lollipop. The ready-to-use lollipops were then labeled and stored in a refrigerator.
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