Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jul 21, 2012; 18(27): 3595-3601
Published online Jul 21, 2012. doi: 10.3748/wjg.v18.i27.3595
Sedation-associated hiccups in adults undergoing gastrointestinal endoscopy and colonoscopy
Chien Cheng Liu, Cheng Yuan Lu, Chih Fang Changchien, Ping Hsin Liu, Daw Shyong Perng
Chien Cheng Liu, Cheng Yuan Lu, Chih Fang Changchien, Ping Hsin Liu, Department of Anesthesiology, E-DA Hospital, I-Shou University, Kaohsiung 82445, Taiwan, China
Daw Shyong Perng, Department of Gastroenterology, E-DA Hospital, I-Shou University, Kaohsiung 82445, Taiwan, China
Author contributions: Liu CC and Perng DS designed the research; Liu CC, Lu CY and Changchien CF performed the research; Liu CC, Liu PH and Perng DS analyzed the data; Liu CC and Perng DS wrote the paper.
Correspondence to: Dr. Daw Shyong Perng, Department of Gastroenterology, E-DA Hospital, I-Shou University, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung 82445, Taiwan, China. machinozomu@mail2000.com.tw
Telephone: +886-7-6150011 Fax: +886-7-6150011
Received: October 8, 2011
Revised: December 12, 2011
Accepted: May 6, 2012
Published online: July 21, 2012
Abstract

AIM: To investigate whether the incidence of hiccups in patients undergoing esophagogastroduodenoscopy (EGD) or same-day bidirectional endoscopy (EGD and colonoscopy; BDE) with sedation is different from those without sedation in terms of quantity, duration and typical onset time.

METHODS: Consecutive patients scheduled for elective EGD or same-day BDE at the gastrointestinal endoscopy unit or the health examination center were allocated to two groups: EGD without sedation (Group A) and BDE with sedation (Group B). The use of sedation was based on the patients’ request. Anesthesiologists participated in this study by administrating sedative drugs as usual. A single experienced gastroenterologist performed both the EGD and the colonoscopic examinations for all the patients. The incidence, duration and onset time of hiccups were measured in both groups. In addition, the association between clinical variables and hiccups were analyzed.

RESULTS: A total of 435 patients were enrolled in the study. The incidences of hiccups in the patients with and without sedation were significantly different (20.5% and 5.1%, respectively). The use of sedation for patients undergoing endoscopy was still significantly associated with an increased risk of hiccups (adjusted odds ratio: 8.79, P < 0.001) after adjustment. The incidence of hiccups in males under sedation was high (67.4%). The sedated patients who received 2 mg midazolam developed hiccups more frequently compared to those receiving 1 mg midazolam (P = 0.0028). The patients with the diagnosis of gastroesophageal reflux disease (GERD) were prone to develop hiccups (P = 0.018).

CONCLUSION: Male patients undergoing EGD or BDE with sedation are significantly more likely to suffer from hiccups compared to those without sedation. Midazolam was significantly associated with an increased risk of hiccups. Furthermore, patients with GERD are prone to develop hiccups.

Keywords: Anesthesia, Midazolam, Hiccup, Gastroesophageal reflux disease, Esophagogastroduodenoscopy, Bidirectional endoscopy