Comparison of Efficacy between Lidocaine Spraying VS Nebulization in Topical Anesthesia for Fiberoptic Endoscopy of Upper Gastrointestinal Tract

Mahattanaviroj O.,M.D.,Valairucha S.,M.D.,Thakulsawadi P.,M.D.,Santawat U.,M.D.

Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700

  We designed a randomized study to compare the efficacy of topical anesthesia for fiberoptic esophagogastrectomy between lidocaine spraying and nebulization. After the Siriraj Hospital Ethical Committee approval, 40 patients (ASA I-II) undergoing elective fiberoptic esophagogastroscopy were allocated into 2 groups, gr I : lidocaine spraying ( n = 20 ) and gr II : lidocaine nebulization ( n = 20 ). Lidocaine was equally administered 3 mg/kg in both groups. The patients were well informed regarding to the anesthetic procedure. The efficacy of topical anesthesia was evaluated by patients, surgeons and the same nurse anesthetist who were blinded to the anesthetic techniques. The results showed no difference in the demographic data and duration of the endoscopic procedure between the two groups. During the anesthetic procedures, the patients' self-assessment of their discomfort, nausea-vomiting, bitterness and mouth dryness were similar in both groups except for coughing. In gr II,the grading of coughing was found to be significantly less than in gr I ( p = 0.08 ). During the endoscopy, the grading of patients' cooperation, discomfort, nausea-vomiting, coughing as well as surgeon's satisfaction were not significantly different in both groups. The endoscopic procedure could be continued without any supplemental drugs to the patients. Neither lidocaine toxicity nor other complications were detected in this study. We concluded that the nebulization technique as compared to the spraying technique could be used in fiberoptic esophagogastroscopy. However the nebulization technique was shown to have less grading of coughing during lidocaine administration.