Anesthetic Lollipop Prepares Patients for Endoscopy

A new study has 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.

Researchers at the American University of Beirut Medical Center (AUBMC, Lebanon) conducted a single-blinded study of 50 patients aged 18 years of age and older with no allergies to lidocaine destined for elective diagnostic upper endoscopy. The participants were randomly assigned to receive 300 mg of lidocaine in the form of either a lollipop or as a spray. In both study groups, the decision to administer subsequent intravenous sedation was based on the blinded endoscopist's assessment of patient discomfort (excessive gagging, retching, restlessness, and combativeness) during any part of the procedure. Immediately after the procedure, the endoscopist filled in a questionnaire rating the quality of the procedure, the tolerability of the patient, the doses of additional sedatives used, and the level of the patient's gag reflex.

The results showed that the lollipop group had less gag reflex, accommodated scope introduction more, and tolerated the procedure better. The majority of participants in the lollipop group were satisfied with their mode of anesthesia compared with the spray group. The use of the lollipop resulted in the elimination of the need for any intravenous sedation in nearly two thirds of patients and the use of lower doses of sedatives in the rest. The study appears in the October 2007 issue of Gastrointestinal Endoscopy.

"We found that 32% of the patients given the lidocaine lollipop required intravenous sedation compared with 96% of the patients who received the spray,” said lead author Assaad Soweid, M.D. "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.”

The researchers speculated that the observed effectiveness of the lollipop could be explained by the continuous release of lidocaine from sucking the lollipop, in addition to swallowing the saliva mixed with the local anesthetic. It allowed for a homogenous and slow spread of the anesthetic providing ample time to exert its effect.


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American University of Beirut Medical Center