Pharyngeal anesthesia is widely used as an adjunct to sedation during upper endoscopy.
Methemoglobinemia and anaphylactic reactions are rare but serious complications of topical anesthetic agents.
Individual studies produce variable results about the effectiveness of pharyngeal anesthesia in improving patient tolerance.
Dr Luke Evans and colleagues performed a systematic review to evaluate the effectiveness of pharyngeal anesthesia.
The researchers assessed whether it improved patient tolerance, and ease of endoscopy during sedated upper endoscopy.
The research team performed MEDLINE, an EMBASE search, and manual searches to identify pertinent English language articles.
| Endoscopists rated the procedure as ‘not difficult' for patients receiving anesthesia|
Randomized controlled trials comparing the efficacy of pharyngeal anesthesia to placebo or no treatment were identified.
Data about patient tolerance of the procedure and endoscopist assessment regarding the ease of endoscopy was extracted in duplicate.
The researchers identified from a pool of 53 studies, only 5 randomized controlled trials that evaluated a total of 491 patients, and provided interpretable data.
Patients who rated their discomfort during the sedated procedure as none/minimal were more likely to have received pharyngeal anesthesia.
The team found that endoscopists were more likely to rate the procedure as ‘not difficult' for patients who received pharyngeal anesthesia.
Lack of standardized outcome measurements and standardized sedation strategies led to heterogeneity in the patient-tolerance portion of the meta-analysis.
Dr Evans' team concluded, “Pharyngeal anesthesia before upper endoscopy improves ease of endoscopy and also improves patient tolerance.”