A Randomised Controlled Trial to Evaluate the Effects of Flumazenil after Midazolam Premedication in Outpatients Undergoing Colonoscopy

Saletin, M.; Malchow, H; Mühlhofer, Heinrich; Fischer, Michael J.M.; Pilot, Jeff; Rohde, H.

doi:10.1055/s-2007-1010709

Cited by 29 publications

(17 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It also shows an anti‐anxiety effect . The effectiveness of midazolam depends on various factors such as dosage, age of patient, cardio pulmonary function, the speed of drug insertion, and the type of drug that is being used along with midazolam . The use of high dosage of midazolam has resulted in hypoxemia in 41% of patients…”

Section: Discussionmentioning

confidence: 99%

Low‐dose midazolam and propofol use for conscious sedation during diagnostic endoscopy

Kim

2019

The Kaohsiung J of Med Scie

View full text Add to dashboard Cite

To find the right sedation technique for different types of treatment methods and the right amount of sedatives so the chances of side effects happening can be reduced. This was a retrospective cohort analysis conducted on prospectively collected data. Patients who underwent esophagogastroduodenoscopy only (E group) were sub‐divided into two subgroups: (a) Those who received 0.5 mg/kg of propofol (E‐a), (b) Those who received 0.025 mg/kg of midazolam and 0.5 mg/kg of propofol (E‐b). Patients who underwent esophagogastroduodenoscopy with colonoscopy (EC group) were also sub‐divided into three subgroups: (a) Those who received 0.5 mg/kg of propofol (EC‐a), (b) Those who received 0.025 mg/kg of midazolam and 0.5 mg/kg of propofol (EC‐b), (c) Those who received 25 mg (12.5 mg if body weight < 50 kg or age > 70) of meperidine and 0.025 mg/kg of midazolam along with 0.5 mg/kg of propofol (EC‐c). When the level of target was not reached, 10‐20 mg of propofol was additionally injected. Sedation efficacy and safety were then compared among groups. E‐b and EC‐b decreased the overall amount of propofol and reduced side effect of temporary hypoxemia compared to E‐a and EC‐a. EC‐b shortened patient recovery time compared to EC‐c and reduced paradoxical reaction. In terms of the patient satisfaction and patient cooperation by endoscopists, there were no significant differences between EC‐b and EC‐c. Concomitant use of low dosages of both propofol and midazolam is found to be useful and safe when endoscopy needs to be performed.

show abstract

Section: Discussionmentioning

confidence: 99%

Low‐dose midazolam and propofol use for conscious sedation during diagnostic endoscopy

Kim

2019

The Kaohsiung J of Med Scie

View full text Add to dashboard Cite

show abstract

“…The antagonistic effect for respiratory depression induced by midazolam appears within 120 s after the i.v. injection of flumazenil, which immediately attenuates or eliminates respiratory depression . The underlying problem in using flumazenil is that re‐sedation may occur because this drug has a shorter duration of action than midazolam.…”

Section: Statements On Sedation In Gastroenterological Endoscopymentioning

confidence: 99%

“…The underlying problem in using flumazenil is that re‐sedation may occur because this drug has a shorter duration of action than midazolam. Because of the above mechanism, patients may awaken temporarily and then spontaneously lose consciousness again . A study compared flumazenil and a placebo given immediately and 30 min after the examination in 50 cases undergoing upper GI endoscopy under sedation with midazolam.…”

Section: Statements On Sedation In Gastroenterological Endoscopymentioning

confidence: 99%

Guidelines for sedation in gastroenterological endoscopy

Obara

Haruma

Irisawa

et al. 2015

Digestive Endoscopy

View full text Add to dashboard Cite

Recently, the need for sedation in gastrointestinal endoscopy has been increasing. However, the National Health Insurance Drug Price list in Japan does not include any drug specifically used for the sedation. Although benzodiazepines are the main medication, their use in cases of gastrointestinal endoscopy has not been approved. This has led the Japan Gastrointestinal Endoscopy Society to develop the first set of guidelines for sedation in gastrointestinal endoscopy on the basis of evidence‐based medicine in collaboration with the Japanese Society for Anesthesiologists. The present guidelines comprise 14 statements, five of which were judged to be valid on the highest evidence level and three on the second highest level. The guidelines are not intended to strongly recommend the use of sedation for gastrointestinal endoscopy, but rather to indicate the policy as to the choice of appropriate procedures when such sedation is deemed necessary. In clinical practice, the final decision as to the use of sedation should be made by physicians considering patient willingness and physical condition.

show abstract

“…injection. 34 Because the action of flumazenil is usually shorter than that of benzodiazepines and sedation may recur, the patient should remain monitored.…”

Section: Sedationmentioning

confidence: 99%

“…injection. 34 Because the action of flumazenil is usually shorter than that of benzodiazepines and sedation may recur, the patient should remain monitored.Adverse effects of sedative drugs include respiratory depression, cardiovascular depression, bradycardia, arrhythmia, anterograde amnesia, disinhibition, and hiccups. According to a US guideline, the following precautions are important for sedation: patient assessment, knowledge about anesthetic/ sedative drugs and resuscitation, monitoring and attendance of a person assigned responsibility for patient assessment, and preparation of a ventilator and emergency kits.…”

mentioning

confidence: 99%

Basic principles and practice of gastric cancer screening using high‐definition white‐light gastroscopy: Eyes can only see what the brain knows

Gotoda

Uedo

Yoshinaga³

et al. 2016

Digestive Endoscopy

View full text Add to dashboard Cite

Endoscopic diagnosis of gastrointestinal tumors consists of the following processes: (i) detection; (ii) differential diagnosis; and (iii) quantitative diagnosis (size and depth) of a lesion. Although detection is the first step to make a diagnosis of the tumor, the lesion can be overlooked if an endoscopist has no knowledge of what an earlystage 'superficial lesion' looks like. In recent years, image-enhanced endoscopy has become common, but white-light endoscopy (WLI) is still the first step for detection and characterization of lesions in general clinical practice. Settings and practice of routine esophagogastroduodenoscopy (EGD) such as use of antispasmodics, number of endoscopic images taken, and observational procedure are customarily decided in each facility in each country and are not well standardized. Therefore, in the present article, we attempted to outline currently available evidence and actual Japanese practice on gastric cancer screening using WLI, and provide tips for detecting EGC during routine EGD which could become the basis of future research.Key words: gastric atrophy, gastric cancer, Helicobacter pylori, Kimura-Takemoto classification, screening gastroscopy MEDICAL INTERVIEW PRIOR TO ESOPHAGOGASTRODUODENOSCOPY M EDICALINTERVIEW BEFORE esophagogastroduodenoscopy (EGD) is important in terms of the following two points. One is to confirm indication of the EGD and the other is to assess risk of examinees. Whether indication for EGD is to screen for early gastric cancer (EGC) or to make a diagnosis of a patient's symptoms or abnormal findings in other diagnostic examinations should be distinguished. In the screening endoscopy, the entire gastric mucosa is thoroughly observed to detect any suspicious findings for neoplasia, whereas only the presence of apparent lesions that may cause symptoms or abnormal image findings are investigated. Although endoscopy is usually intended to make a diagnosis of symptoms or abnormal findings in other diagnostic images, EGC are often found in patients with neither obvious symptoms nor abnormal findings in other diagnostic tests.1 Therefore, in high-risk patients, it is important to screen for EGC unrelated to symptoms or abnormal find-ings of other diagnostic tests during EGD. The examinee should be asked about status and history of eradication therapy of Helicobacter pylori (H. pylori), 2-4 family history of gastric cancer, smoking and drinking habits. [5][6][7][8] Another reason for the medical interview is to reduce 10 and an anti-foaming agent 11 reduces time and effort for washing out mucus or bubbles to improve quality of observation. A mixture of 4 mL anti-foaming agent (dimethicone, Gascon ® 20 mg/mL; Horii Pharmaceutical Industry, Osaka Japan), 20 000 U mucolytic agent (Pronase MS ® ; Kaken Pharmaceutical, Tokyo, Japan), and 1 g sodium bicarbonate dissolved in 50 mL water is given 10 min before the examination. 12Usefulness of a topical pharyngeal anesthetic is controversial although it is commonly used before gastroscopy. 13,14 UK data show that to...

show abstract

A Randomised Controlled Trial to Evaluate the Effects of Flumazenil after Midazolam Premedication in Outpatients Undergoing Colonoscopy

Cited by 29 publications

References 0 publications

Low‐dose midazolam and propofol use for conscious sedation during diagnostic endoscopy

Low‐dose midazolam and propofol use for conscious sedation during diagnostic endoscopy

Guidelines for sedation in gastroenterological endoscopy

Basic principles and practice of gastric cancer screening using high‐definition white‐light gastroscopy: Eyes can only see what the brain knows

Contact Info

Product

Resources

About