Hiccups during endoscopy

[VaporMD]

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Anyone have any advice for treating hiccups during endoscopy (assume patient is adequately sedated with propofol). It happens infrequently and typically resolves within a few minutes- but very annoying when it occurs during a critical part of a case!

 

[deleted171991]

There is a simple and perfect solution to it, works like magic, and we should stop sharing it publicly.

Physicians should also stop writing professional books that are sold to non-physicians; it's like teaching thousands of midlevels at once how to replace a physician.

All the threads with professional advice on this forum should be in the private section. We are such stupid suckers.

 

[VaporMD]

Wowza! Haha- ok if this can be moved to the private thread please do so.

 

[PieOHmy]

Think about it. Patients who are adequately or deeply sedated dont hiccup.
GIVE MORE PROPOFOL until the hiccuping stops.

 

[deleted171991]

Think about it. Patients who are adequately or deeply sedated dont hiccup.
GIVE MORE PROPOFOL until the hiccuping stops.

Incorrect!

 

[Hork Bajir]

Really? The dude came to a forum for physicians, and asked a question with the goal of bettering his practice. So what if a CRNA reads it and learns your magical answer? If a CRNA calls you for help with this issue, are you going to make them close their eyes and turn around while you fix it? If a CRNA takes your job, knowledge from this forum won’t be the reason why.

BTW OP, small doses of haldol sometimes work well for this purpose. Not sure if this is the magical answer to which FFP was referring

 

[jwk]

I'm a fan of lidocaine myself - but then I was brought up by Steinhaus at Emory. Lidocaine cures everything, including cough due to cold and the heartbreak of psoriasis.

 

[deleted162650]

Sux

 

[Arch Guillotti]

Wowza! Haha- ok if this can be moved to the private thread please do so.

It can be since you are the OP. I don’t think it needs to be though.

 

[MoMoGesiologist]

I'm a fan of lidocaine myself - but then I was brought up by Steinhaus at Emory. Lidocaine cures everything, including cough due to cold and the heartbreak of psoriasis.

Are you giving it IV and how much?

 

[PieOHmy]

I hope a CRNA or multiple CRNAs read this:

Physician Assistant in Anesthesia is the future.
Anesthesia Care Team will LIVE forever.
PAs will replace the CRNA in the next 10-20 years

 

[coffeebythelake]

I'm a fan of lidocaine myself - but then I was brought up by Steinhaus at Emory. Lidocaine cures everything, including cough due to cold and the heartbreak of psoriasis.

i'm a fan of lidocaine as well, in this situation, IV usually 0.5-1 mg/kg bolus

 

[AdmiralChz]

Good lord, this forum is going down the tubes. Answer the guys question and move on.

 

[deleted643396]

Don’t tell the CRNAs, but the cure for hiccups is to duck beneath the stretcher then jump up suddenly and yell BOO! Works every time.

 

[IlDestriero]

I hope a CRNA or multiple CRNAs read this:

Physician Assistant in Anesthesia is the future.
Anesthesia Care Team will LIVE forever.
PAs will replace the CRNA in the next 10-20 years

 

[IlDestriero]

I give a 1-1.5 mg/kg bolus of lidocaine. But it doesn’t work like magic and sometimes they still keep going.
I’m always open to learn a better approach. Maybe it’s a trade secret?
No solo CRNA would want to touch my cases with a barge pole, so I’m not so worried about that. Maybe the “GI anesthesiologist” should though.

 

[MoMoGesiologist]

I give a 1-1.5 mg/kg bolus of lidocaine. But it doesn’t work like magic and sometimes they still keep going.
I’m always open to learn a better approach. Maybe it’s a trade secret?
No solo CRNA would want to touch my cases with a barge pole, so I’m not so worried about that. Maybe the “GI anesthesiologist” should though.

Don’t worry, we will make GI anesthesia a fellowship to try and keep the CRNAs out. No way they can keep up!

 

[AdmiralChz]

The magic bullet is obviously Pavulon.

 

[deleted87051]

The magic bullet is obviously Pavulon.

That works extremely well when they can’t lie still for a CAT scan too.

 

[deleted162650]

That works extremely well when they can’t lie still for a CAT scan too.

I believe that technique was pioneered at Vanderbilt.



Too soon??

 

[VaporMD]

Really? The dude came to a forum for physicians, and asked a question with the goal of bettering his practice. So what if a CRNA reads it and learns your magical answer? If a CRNA calls you for help with this issue, are you going to make them close their eyes and turn around while you fix it? If a CRNA takes your job, knowledge from this forum won’t be the reason why.

BTW OP, small doses of haldol sometimes work well for this purpose. Not sure if this is the magical answer to which FFP was referring

Thanks! What dose and route are you using?

 

[Hork Bajir]

Usually 1mg at a time, up to 5mg depending on the patient- 18yo dude can take 5mg no problem, little old lady wouldn’t give more than 1mg. Not sure what the dose response curve for hiccups looks like tho- ie if it doesn’t work above X dose, it isn’t going to work. Anyone else have experience using it for this purpose? TBH I’ve used it more for hiccups during LMA cases, but same idea

 

[BlueRug]

Pretty sure the magic FFP is referring to involves a reflex arc....

 

[PieOHmy]

I personally wouldnt use haldol in an outpatient setting. The response is variable. At an outpatient endoscopy center, you re basically moving meat. Like 30 patients per day need to get undressed, scoped, recover back dressed and out the door. you dont need haldol getting in the way. Just give more propofol. The reason they hiccup during an upper egd is the endocopists blows air in the belly to distend it. YOu put too much air you get phrenic irritability. either that or they are light. In either case.. just give more propofol.

 

[Urzuz]

Nonpharmacologic Management of Acute Singultus (Hiccups)

What I use every time a patient develops hiccups, has worked without fail.

 

[deleted171991]

Pretty sure the magic FFP is referring to involves a reflex arc....

Getting warmer.

I don't use any medication. And I'm pretty sure I learned the technique on SDN.

 

[deleted171991]

Nonpharmacologic Management of Acute Singultus (Hiccups)

What I use every time a patient develops hiccups, has worked without fail.

That's exactly it. Works like a charm, does not have to be a trumpet; can be a suction catheter, too. The faces of the GI people: priceless.

And yes, we should stop sharing this kind of tricks on the public Internet. Took me friggin' 5 years to learn about it. Glad to pass it on, just not to people fighting to replace us.

 

[abolt18]

Nonpharmacologic Management of Acute Singultus (Hiccups)

What I use every time a patient develops hiccups, has worked without fail.

Cool, thanks. Will definitely try this!

 

[woopedazz]

There is a simple and perfect solution to it, works like magic, and we should stop sharing it publicly.

Physicians should also stop writing professional books that are sold to non-physicians; it's like teaching thousands of midlevels at once how to replace a physician.

All the threads with professional advice on this forum should be in the private section. We are such stupid suckers.

I'm not able to become a member of the private forum, so I like it when people do some teaching on the public one.

 

[IlDestriero]

Nonpharmacologic Management of Acute Singultus (Hiccups)

What I use every time a patient develops hiccups, has worked without fail.

Of course that article is written by JBU.

 

[jwk]

The magic bullet is obviously Pavulon.

Ah, I remember it well, tachycardia and all.

 

[deleted171991]

I'm not able to become a member of the private forum, so I like it when people do some teaching on the public one.

Tough luck. There is no reason for any anesthesiologist, anesthesia resident or medical student, to not be able to become a member of the private forum.

 

[Arch Guillotti]

Tough luck. There is no reason for any anesthesiologist, anesthesia resident or medical student, to not be able to become a member of the private forum.

No.

 

[coffeebythelake]

Of course that article is written by JBU.

Pardon my ignorance, who is JBU

 

[IlDestriero]

Pardon my ignorance, who is JBU

John Brock-Utne.
Legendary Stanford clinician who wrote several interesting case based books on anesthesia full of pearls from top to bottom. Should be required reading. Hit up amazon and spend some of that PE account cash.