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Sedation, Topical Pharyngeal Anesthesia and Cardiorespiratory Safety During Gastroscopy

Ristikankare, Matti MD, PhD*; Julkunen, Risto MD, PhD*; Heikkinen, Markku MD, PhD*; Mattila, Matti MD, PhD; Laitinen, Tomi MD, PhD; Wang, Shi-Xuan MD, PhD; Hartikainen, Juha MD, PhD*

Journal of Clinical Gastroenterology: November-December 2006 - Volume 40 - Issue 10 - p 899-905
doi: 10.1097/01.mcg.0000225579.65761.b1
Alimentary Tract: Clinical Research

Goals In a prospective, double-blind study, we examined the effects of routine sedation and pharyngeal anesthesia on cardiorespiratory parameters during gastroscopy.

Background Intravenous sedation and topical pharyngeal anesthesia are used to alleviate the discomfort during upper gastrointestinal endoscopy. Cardiorespiratory changes during gastroscopy are common.

Study Two hundred fifty two consecutive outpatients undergoing gastroscopy were assigned into 4 groups: (1) sedation with intravenous midazolam and placebo throat spray (midazolam group), (2) placebo sedation and pharyngeal anesthesia with lidocaine throat spray (lidocaine group), (3) placebo sedation and placebo throat spray (placebo group), and (4) no intravenous cannula nor throat spray (control group). Arterial oxygen saturation (SaO2), systolic and diastolic blood pressure and continuous electrocardiogram were recorded before, during, and after the endoscopic procedure.

Results Gastroscopy increased heart rate in all study groups. Premedication with intravenous midazolam or lidocaine spray alleviated this rise (P<0.001, repeated measures analysis of variance) and decreased the incidence of tachycardia. Similarly, sedation with midazolam or topical pharyngeal anesthesia decreased the rise in systolic blood pressure (P<0.001). Midazolam produced lower SaO2 values during gastroscopy compared with lidocaine, placebo or control groups (P<0.001). However, episodes of desaturation (SaO2 ≤92) were no more common in the midazolam group than in other groups.

Conclusions Premedication with midazolam alleviated the rise in heart rate and systolic blood pressure but induced a statistically significant decrease in arterial oxygen saturation. However, gastroscopy proved to be a safe procedure both with and without sedation.

Departments of *Medicine


Clinical Physiology, Kuopio University Hospital, Kuopio, Finland

Reprints: Dr Matti Ristikankare, MD, PhD, Laakso Hospital, 00099 Helsinki, PL 6600, Finland (e-mail:

Received for publication January 30, 2006; accepted June 7, 2006

© 2006 Lippincott Williams & Wilkins, Inc.