Oropharyngeoesophageal Topical Anesthesia Versus Propofol - Ketamine Sedation for Upper Gastrointestinal Endoscopy

Summary

Esophagogastroduodenoscopy (EGD) is an essential and widely used diagnostic and therapeutic procedure in gastroenterology. EGD can be performed in association with topical anesthesia of the pharynx, intravenous anesthesia, or with their combination. Sedation is required to alleviate anxiety, provide analgesia, amnesia and to improve endoscopic performance specifically in therapeutic procedures. However, sedation-related gastrointestinal endoscopy complications when occur, may lead to significant morbidity and occasional mortality especially with moderate and deep sedation. Cardiopulmonary complications resulting from aspiration, oversedation, hypoventilation, vasovagal reflex, and airway obstruction account for more than 50% of all complications associated with upper endoscopy. Topical pharyngeal anesthesia currently is a requirement for upper endoscopy to provide patients with the best comfort in unsedated EGD. In Hong Kong, 10% Xylocaine pump spray (AstraZeneca, Sodertalje, Sweden) is the pharyngeal anesthesia generally used as a premedication in unsedated EGD. The aim of this study was to provide more effective, safer, tolerable and offers quicker recovery technique using either the modified Oropharyngeoesophageal Topical Anesthesia (OPETA) technique or conventional intravenous sedation by prepared mixture of propofol and ketamine (ketofol 4:1) .

Timeline

Start

2023-01-01

Primary completion

2023-07-01

Completion

2023-07-30

Publications

• Background Amornyotin, S. (2015). Anesthesia innovations for endoscopy of gastrointestinal tract. Endoscopy-innovative uses and emerging technologies. Croatia: InTech, 39-61.
• Background de la Morena F, Santander C, Esteban C, de Cuenca B, Garcia JA, Sanchez J, Moreno R. Usefulness of applying lidocaine in esophagogastroduodenoscopy performed under sedation with propofol. World J Gastrointest Endosc. 2013 May 16;5(5):231-9. doi: 10.4253/wjge.v5.i5.231.
• Background hfeda, M. A. M., Ganaw, A., Ahmed, S. M. G., Chanda, A., Mahood, Z., Jabira, S., et al . (2021). Anaesthetic Considerations in Gastrointestinal Endoscopies. In Esophagitis and Gastritis-Recent Updates. (Edited by Vincenzo Neri and Monjur Ahmed) Ch 9, P. 141- 158. BoD- Book on Demand .
• Background Feng AY, Kaye AD, Kaye RJ, Belani K, Urman RD. Novel propofol derivatives and implications for anesthesia practice. J Anaesthesiol Clin Pharmacol. 2017 Jan-Mar;33(1):9-15. doi: 10.4103/0970-9185.202205.
• Background Heuss LT, Hanhart A, Dell-Kuster S, Zdrnja K, Ortmann M, Beglinger C, Bucher HC, Degen L. Propofol sedation alone or in combination with pharyngeal lidocaine anesthesia for routine upper GI endoscopy: a randomized, double-blind, placebo-controlled, non-inferiority trial. Gastrointest Endosc. 2011 Dec;74(6):1207-14. doi: 10.1016/j.gie.2011.07.072. Epub 2011 Oct 13.
• Background Kamalipour, H., Joghataei, P., & Kamali, K. (2009). Comparing the Combination Effect of Propofol-Ketamine and Propofol-Alfentanil on Hemodynamic Stability during Induction of General Anesthesia in the Elderly.
• Background Nofal O. Awake light-aided blind nasal intubation: prototype device. Br J Anaesth. 2010 Feb;104(2):254-9. doi: 10.1093/bja/aep367. Epub 2009 Dec 26.

Drugs

Indications

No indication recorded.