Premedication and Medications Used During the Procedure

It is not strictly necessary to premedicate or medicate patients for upper GI endoscopy. The use and selection of medications should be tailored to the individual case. The following types of medication may be used:

► Local anesthetics

► Analgesics

► Antispasmodics

► Defoaming agents

Local Anesthesia

Indication

► Pharyngeal anesthesia can be used in any endoscopic procedure.

Contraindications

► Emergency endoscopy (increased risk of aspiration)

► Known hypersensitivity

Advantage

► Better patient tolerance of the examination

Disadvantages

► Increased risk of aspiration

► Allergic reaction

► Swallowing difficulties after the examination

Method

► Two squirts of lidocaine sprayed into the pharynx Precautions

► Nothing by mouth from 30 minutes to one hour after the examination

Sedation

Indications

► Requested by the patient

► Very anxious patient

Contraindications

► Paradoxical reaction

► Risk of aspiration

Method

► Emergency endoscopy in a nonintubated patient

► Respiratoryfailure

► Circulatory failure

► Goal is conscious sedation

► Midazolam (Dormicum), 2-5 (up to 10) mg i. v., halflife two to three hours

► Diazepam (Valium), 5-20 mg i.v., half-life 30 hours (!)

Advantages

Precautions

Improves subjective patient tolerance

Close patient surveillance

Makes examination easier to perform

Pulse oximetry

Suppresses sympathetic outflow

Intravenous line

Reduces hypertension, arrhythmias, coronary

Have O2 available

ischemia

Have antagonists available: flumazenil (Anexate)

Caution: Midazolam has a longer half-life than

Disadvantages

flumazenil

► Respiratory depression

► Less cooperative patient

Analgesia

Indications

► Indicated only for painful procedures

- Bougie or balloon dilatation, PEG placement

Contraindications

► Emergency endoscopy in a nonintubated patient

► Respiratory failure

► Circulatory failure

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