Effect Of Pharyngeal Stimulation And Atropine Injection For Hiccups During Painless Gastrointestinal Endoscope

Background and Objective:In addition to hemodynamic or respiratory depression,the other frequently encountered clinical situation during endoscopic procedures with sedation is hiccups.Hiccups consist of eratic diaphragmatic intercostal muscle myoclonus followed by laryngeal closure,The abrupt rush of air entry creates the characteristic “hic”sound.Hiccups during painless gastrointestinal endoscope not only bring some troubles to the operators,but also increase the risks associated with anesthesia,such as negative pressure pulmonary edema,arrhythmias,Mallory-Weiss syndrome and other complications.Two special methods for the treatment of intraoperative hiccups have been described in the previous literature,namely,pharyngeal stimulation and atropine0.5mg injection.However,there is no experimental proof of its efficacy,and there is no literature report on the efficacy of combined application of both for hiccups.In addition,hiccups are self-limited,and a considerable number of hiccups stop spontaneously before therapeutic intervention.Therefore,The subjects of this study were those with hiccups occurring during gastrointestinal endoscope(after the endoscopy begins)and lasting more than 1min,to prove the effectiveness of atropine injection and pharyngeal stimulation on intraoperative hiccups,and to find a simple and efficient treatment scheme to stop hiccups during painless gastrointestinal endoscope timely.Methods:A total of 96 patients(with painless gastrointestinal endoscope ASA I-III grade)were enrolled in this study.The patients were randomly divided into six groups with 16 in each group:The atropine-pharyngeal stimulation group(AP group),the pharyngeal stimulation-atropine group(PA group),the pharyngeal stimulation group(P group),the observation group(O group),the atropine group(A group),the saline group(NS group).Intravenous access was established after admission,and oxygen inhalation through nasal catheter(4L/min)was performed for each patient.Routine monitoring included electrocardiogram,noninvasive blood pressure,and pulse oxygen saturation.During the process of gastrointestinal endoscope,if hiccups occurred,1minute were given to wait for spontaneous cessation;if not,they were immediately included into the groups:Group 1(AP group): 0.5mg atropine was given intravenously and observed for 2 minutes,if hiccups don’t stop,then received pharyngeal stimulation.If the hiccups stopped,the stimulation was stopped.If not,the stimulation was continued for 30 seconds.Group 2(PA group):Stimulating pharyngeal immediately,if the hiccups stopped,the stimulation was stopped.If the hiccups failed to stop,the stimulation was continued for 30 seconds.If hiccups still don’t stop,the patient was given atropine 0.5mg intravenous injection,and observed for 2 minutes.Group 3(group A): 0.5mg atropine was given intravenously and observed for 2 minutes.Group 4(NS group):the same amount of normal saline was given and observed for 2 minutes.Group5(group P): Stimulation of the pharyngeal was performed.If the hiccups stopped,the stimulation was stopped.If not,the stimulation was continued for 30 seconds.Group 6(Group O): do not dispose,observe for 30 seconds.In this experiment,three time points were set.The effective rate of pharyngeal stimulation was observed at One minute and thirty seconds(T1)after the onset of hiccups(the onset time of pharyngeal stimulation is generally within 30S).At three minutes after the onset of hiccups(T2),the effective rate of atropine was mainly observed(the onset time of atropine is generally less than 2 minutes).The final effective rate in the AP and PA groups was observed at 3 minutes and 30 seconds after the onset of hiccups(T3).The effective rates of terminating hiccup in AP group and PA group,A group and NS group,P group and O group,P group and PA group were compared at 3time points.Results:There was no significant difference in general data among all groups(P=0 0.05).At T1,the effective rate of PA group(87.5%)was significantly higher than that of AP group(12.5%),and the difference was statistically significant(P=0.000).The effective rate of A group(6.3%)and NS group(12.5%)were very low,and there was no statistical difference between the two groups(P=1.000).The effective rate of P group(87.5%)was significantly higher than that of O group(12.5%),with statistical difference(P=0.000).Both PA group(87.5%)and P group(87.5%)had high effective rate,and there was no statistical difference between the two groups(P=1.000).At T2,the effective rate of PA group(93.8%)was still higher than that of AP group(53.6%),but there was no statistical difference(P=0.410).The effective rate of group A(53.6%)and group NS(50%)were very low,and there was no statistical difference between the two groups(P=0.723).The effective rate of P group(87.5%)was still higher than that of O group(50%),with statistical difference(P=0.022).The effective rate of PA group(93.8%)and P group(87.5%)had high effective rate,and there was no statistical difference between the two groups(P=1.000).At the moment of T3,both PA group(93.8%)and AP group(93.8%)had high effective rate,and there was no statistical difference between the two groups(P=1.000).The effective rate of group A(62.5%)and group NS(56.3%)were low,and there was still no statistical difference between the two groups(P=1.0.719).The effective rate of P group(87.5%)was still higher than that of O group(56.3%),but there was nostatistical difference(P=0.116).Both PA group(93.8%)and P group(87.5%)had high effective rate,and there was no statistical difference between the two groups(P=1.000).Conclusions:In this study,pharyngeal stimulation was shown to be effective in terminating hiccups during painless gastrointestinal endoscope,whereas atropine injection proved ineffective.Furthermore,when hiccups occur during painless gastrointestinal endoscope,immediate pharyngeal stimulation is the simplest and most effective option compared to other treatment options.