The suppression of Hiccups after Laryngeal Mask Airway insertion by Atropine: a systematic review

Introduction: Hiccup is the sudden onset of erratic diaphragmatic and intercostal muscle contraction and immediately followed by laryngeal closure. Acute hiccup is a minor complication that can occur during sedation or general anaesthesia. The objective was to perform a systematic search for treating hiccup occurring with LMA insertion. Method: A systematic search for reports describing interventions to treat hiccup during anesthesia was carried out (MEDLINE, EMBASE, Cochrane-Library, manual screening of reference lists and review articles, up to ۲۰۲۲). Search terms were anesthesia, LMA , hiccup Result: After search and analysis, finally ۷ full text articles selected. based on studies A rapid phasic distension of the proximal esophagus can cause hiccups in normal subjects, but a slow ramp distension or distal esophagus does not cause hiccups. Therefore, a sudden rapid stretch of the mechanoreceptors in the pharynx might trigger the hiccup reflex. If this is true, atropine should be effective in relieving a vagal reflex. Indeed, cervical epidural block for blocking the vagus and/or the phrenic nerve is effective in postoperative intractable hiccups. Studies show two possible mechanisms of action for the suppression of hiccups by atropine. First, atropine could act directly on the esophagus by means of decreasing intraesophageal pressure. Second, atropine may act indirectly on the central nervous system via enhancement of sympathetic nerve activity. Conclusion: In conclusion, in a case of severe hiccups after LMA insertion and not responding to conventional methods of treatment, administration of IV atropine can prove beneficial. Although further clinical investigation is needed to be sure more.

کلیدواژه ها:

anesthesia ، LMA ، hiccup