Posterior lingual lidocaine: a novel method to improve tolerance in upper gastrointestinal endoscopy.

AIM: To evaluate the effect of posterior lingual lidocaine swab on patient tolerance to esophagogastroduodenoscopy, the ease of performance of the procedure, and to determine if such use will reduce the need for intravenous sedation. METHODS: Eighty patients undergoing diagnostic esophagogastroduodenoscopy in a tertiary care medical center were randomized to either lidocaine swab or spray. Intravenous meperidine and midazolam were given as needed during the procedure. RESULTS: Patients in the lidocaine swab group (SWG) tolerated the procedure better than those in the spray group (SPG) with a median tolerability score of 2 (1, 4) compared to 4 (2, 5) (P < 0.01). The endoscopists encountered less difficulty performing the procedures in the SWG with lower median difficulty scores of 1 (1, 5) compared to 4 (1, 5) in the SPG (P < 0.01). In addition, the need for intravenous sedation was also lower in the SWG compared to the SPG with fewer patients requiring intravenous sedation (13/40 patients vs 38/40 patients, respectively, P < 0.01). The patients in the SWG were more satisfied with the mode of local anesthesia they received as compared to the SPG. In addition, the endoscopists were happier with the use of lidocaine swab. CONCLUSION: The use of a posterior lingual lidocaine swab in esophagogastroduodenoscopy improves patient comfort and tolerance and endoscopist satisfaction and decreases the need for intravenous sedation.

Treatment and prevention of hepatitis B and C in thalassemia.

Patients with thalassemia have disturbances in hemoglobin chain production which leads to anemia requiring long-term and multiple transfusions, increasing the risk for transfusion-related viruses, including hepatitis B and C viruses. Although this transfusion-related risk has been virtually eliminated with optimal blood screening practices, a significant number of patients transfused prior to 1990 are infected with hepatitis C virus. Treatment of hepatitis B and hepatitis C has improved rapidly leading to viral eradication - or control of viral replication - with the aim of stopping the progression to liver cirrhosis and its complications. Treatment of chronic hepatitis B in patients with thalassemia does not differ from that of other patients. However, current treatment of hepatitis C necessitates the use of ribavirin, which is associated with dose-dependent hemolysis, requiring adjustment of the transfusion protocol for thalassemia patients during the treatment period. Several measures should be taken in thalassemia patients to prevent viral infection including vaccination for hepatitis B and adequate screening of blood and blood products.