Efficacy of Sedation by Midazolam in Association With Meperidine or Fentanyl and Role of Patient Distress During Elective Colonoscopy

Abstract

Meperidine and fentanyl are opioids currently used in addition to midazolam for sedation and analgesia during colonoscopy in Italy. The aim of the study was to assess the impact of patients' psychological state before elective colonoscopy on the efficacy of the sedation regimens. Eighty outpatients who underwent an elective colonoscopy were included in our study. The Hospital Anxiety and Depression Scale questionnaire was self-administered to evaluate basal anxiety and depression state. The rate of baseline discomfort was evaluated by a standard 100-mm visual analog scale. Sedation was obtained alternatively with a midazolam–meperidine or midazolam–fentanyl combination. There were no statistically significant differences between the fentanyl and meperidine groups on body mass index, age, and gender composition. Patients in the meperidine group reported less pain during colonoscopy than patients in the fentanyl group. There were statistically significant positive correlations in the meperidine group with the distress, anxiety, and depression. Our study has pointed out greater effectiveness of the midazolam plus meperidine regimen, equal recovery times, and no significant differences in the duration of the endoscopic examinations. The evaluation of patients' psychological status seems to predict the efficacy of sedation when the nociceptive component of pain is well controlled.

Factors of easy and difficult cecal intubation during unsedated colonoscopy

“…Patients with emotional processing difficulties may also be more likely to have anxiety, which can increase pain during colonoscopy and influence patient's colonoscopy experiences (29). Sedated colonoscopy seems to be more appropriate for such patients (30)(31)(32).…”

Efficacy and safety of EBUS‐TBNA under conscious sedation with meperidine and midazolam

“…17,19 The aim of this study was to assess efficacy and safety of EBUS-TBNA under conscious sedation with meperidine and midazolam performed by pulmonologists, in terms of complete sampling of lymph nodes after consulting radiological imaging, diagnostic yield, and patient's satisfaction. The choice of these drugs is related with the current evidences: midazolam is the most used and recommended drug for conscious sedation during flexible bronchoscopy, 20,21 whereas meperidine, although discussed, 22 has been widely investigated and used both in bronchoscopic procedures 23 and in digestive endoscopic procedures 24,25 with good results.…”