All patients received oxygen at 2 L/min rate during the procedure via nasal cannula. Endoscopy nurse recorded cardiac apex beat, peripheral oxygen saturation and arterial blood pressure. Patients were monitored throughout the procedure. According RSS, R5 (deep sedation, patient only reacts to painful stimulus) was accepted as contraindication for additional doses of midazolam. Scoring in RSS scale is ranked in 6 points based on patient's reaction and cooperation.
Effectiveness of sedation was assessed by the endoscopist using modified Ramsay sedation scale (RSS). EGD procedure was performed by pediatric endoscopist, using EG530 WR (diameter 9.4 mm Fujinon, Tokyo, Japan). Prior to sedation, endoscopy nurse as random applied topical lidocaine 10 % with pump spray at 1 mg/kg dose (Xylocaine AstraZeneca, Silk Road, UK) and distilled water with mint oil via identically scaled pump spray in a double-blind. Sedation with the doses specified above was accepted as normal dose, whereas in case a smaller dose was sufficient for sedation, it was accepted as low-dose. In cases, slow IV infusion of midazolam (Dormicum Roche, İstanbul, Turkey) at 0.1 mg/kg (maximum 4 mg) dose was followed by IV ketamine (Ketalar Pfizer, Sandwich, UK) at 0.5 mg/kg (maximum 2 mg/kg) dose administered. The study was conducted on class 1 and class 2 patients according to the classification of American Society of Anesthesiologists. The aim of our study is to investigate efficacy of topical lidocaine spray for sedated EGD in children. Topical lidocaine spray is often used during endoscopic procedures performed in adults but has a limited use in pediatric practice. Additionally, topical lidocaine suppresses gag reflex which is frequently observed during EGD, and therefore increases both patient's and endoscopist's satisfaction. Several studies have found the lidocaine pharyngeal anesthesia to be beneficial. Traditionally, topical lidocaine spray is used in combination with intravenous (IV) analgesics and sedatives in EGD, and increases success rate of endoscopy. To increase patient tolerance, EGD is generally performed using topical pharyngeal anesthesia and/or sedation. Esophagogastroduodenoscopy (EGD) is an essential and very commonly used procedure for the evaluation of a multitude of gastrointestinal (GI) symptoms including abdominal pain, hemorrhage, dysphagia, odynophagia, and reflux.
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