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

Kim, Joo Hyung; Kim, Dae Hyun; Kim, Jin Hong

doi:10.1002/kjm2.12028

Cited by 5 publications

(6 citation statements)

References 36 publications

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“…In a prospective multicentre study, including 11,701 gastrointestinal endoscopy patients, Sieg et al [21] found that few cases of hypotension (0.02%), bradycardia (0.05%), and hypoxaemia (0.5%) occurred for a sedation regimen consisting of 2-3 mg midazolam plus 10-20 mg propofol followed by boluses of 20-30 mg propofol. The incidence of side effects related to midazolam combined with propofol was comparable to previous studies, which also used similar propofol and midazolam doses for endoscopy sedation [19][20][21].…”

Section: Discussionsupporting

confidence: 83%

“…Be- cause of the lack of analgesic efficacy when used as a single agent during endoscopic sedation, higher doses of propofol are required to maintain the desired level of sedation and increase cardiorespiratory side effects [15,16]. The addition of an opioid and/or midazolam to propofol may help to reduce propofol consumption and, thus, the incidence of side effects [16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

“…There are no clinical trials to directly compare the combination of propofol and IV midazolam or IN sufentanil. In a study in which sedation was performed with an IV loading dose of 2.5 mg midazolam before repeated doses of 20-40 mg propofol during colonoscopy, Delius et al [19] reported that hypotension (< 90/50 mm Hg) and hypoxemia (SpO 2 < 90%) were observed in 2 (1.7%) and 6 (5.2%) of 115 patients, respectively, but there was no bradycardia (< 50 bpm). In a prospective multicentre study, including 11,701 gastrointestinal endoscopy patients, Sieg et al [21] found that few cases of hypotension (0.02%), bradycardia (0.05%), and hypoxaemia (0.5%) occurred for a sedation regimen consisting of 2-3 mg midazolam plus 10-20 mg propofol followed by boluses of 20-30 mg propofol.…”

Section: Discussionmentioning

confidence: 99%

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Combination of propofol and nasal sufentanil or intravenous midazolam for colonoscopy: a comparative study

Ayazoğlu¹,

Uzman²

2021

ait

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The intranasal (IN) route to deliver medications is preferable because this method has advantages over the other methods, such as intravenous (IV), intramuscular, and subcutaneous. The advantages include painless and needleless application, rapid drug absorption, avoidance of gastrointestinal destruction, and hepatic first-pass metabolism [1,2]. Previous studies have shown that the use of IN opiates is effective for mild to moderate sedation but not for deep sedation [3]. The most proper synthetic opiate medication for IN drug delivery is sufentanil because it has high lipid solubility, a short half-life (15 to 20 minutes), rapid onset of action causing rapid mucosal absorption, and large therapeutic index [4]. The administration of IN sufentanil provides preoperative sedation within 10 minutes, and it has been reported to cause less respiratory depression in comparison to fentanyl [5]. Intranasal administration of sufentanil induces no clinically significant change in

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Combination of propofol and nasal sufentanil or intravenous midazolam for colonoscopy: a comparative study

Ayazoğlu¹,

Uzman²

2021

ait

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“…At present, the sedative drugs used in clinical endoscopy are mainly midazolam and propofol. Midazolam has a long duration of action and slow recovery from anesthesia (6,7). In addition to the injection site pain, propofol also has strong respiratory and circulatory inhibitory effects, thus increasing the incidence of accidental risks such as hypoxemia, hypotension, and cardiac arrest (8,9).…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Remimazolam in Endoscopic Sedation—A Systematic Review and Meta-Analysis

Zhu

Wang

et al. 2021

Front. Med.

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Background: The aim of this systematic review and meta-analysis was to investigate the efficacy and safety of remimazolam in clinical endoscopic procedure sedation.Methods: The authors searched the databases of PubMed, Embase, and Cochrane Library for studies published until January 2, 2021, that reported remimazolam sedation for endoscopic procedures. The sedative efficiency and the incidence of adverse events were assessed as outcomes. Cochrane Review Manager Software 5.3 was used to perform the statistical analyses.Results: Seven relevant studies involving a total of 1,996 patients were identified. We conducted a meta-analysis of the different controls used in the studies, that is, the placebo, midazolam, and propofol. The results demonstrated that remimazolam had a strong sedative effect, and its sedative efficiency was significantly higher than that of placebo [OR = 0.01, 95% CI: (0.00, 0.10), I2 = 30%, p <0.00001]. The sedative efficiency of remimazolam was significantly higher than that of midazolam [OR = 0.12, 95% CI: (0.08, 0.21), I2 = 0%, p < 0.00001] but lesser than that of propofol [OR = 12.22, 95% CI: (1.58, 94.47), I2 = 0%, p = 0.02]. Regarding the adverse events, remimazolam is associated with a lower incidence of hypotension than placebo and midazolam. Similarly, remimazolam was associated with a lower incidence of hypotension and hypoxemia than propofol.Conclusions: Remimazolam is a safe and effective sedative for patients undergoing endoscopic procedures. The sedative efficiency of remimazolam was significantly higher than that of midazolam but slightly lower than that of propofol. However, the respiration and circulation inhibitory effects of remimazolam were weaker than those of midazolam and propofol.

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“…10 When sedating a patient for endoscopy, the aim is moderate sedation. 11,12 However, the level of patient consciousness may vary by operator and patient because the depth of sedation depends on the quantity of sedatives used and the patient's response. 11,13 It is very important to maintain an appropriate level of sedation.…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting Recovery Time after Sedation for Upper Gastrointestinal Endoscopy

Jin

Shin²,

Myung

2020

Chonnam Med J

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The purpose of this study was to investigate factors affecting recovery time after sedation for upper gastrointestinal endoscopy. The study population included 1310 patients in the national gastric cancer screening program who received sedation for upper gastrointestinal endoscopy from April 15, 2015 to December 31, 2018. Multivariate regression analysis was performed to identify factors related to recovery time. The mean recovery time after examination was 51.2 minutes (SD=13.3). Patients with a history of hypertension had a recovery time 2.59 minutes shorter than that of patients without hypertension (p=0.006, Bonferroni-corrected p=0.108). Patients with a history of stroke had a recovery time 9.41 minutes longer than that of patients without stroke (p=0.007, Bonferroni-corrected p=0.124). Patients who received 3 mg midazolam had a recovery time 2.99 minutes longer than that of patients received 2 mg (p=0.001, Bonferroni-corrected p=0.010), and patients who received less than 6 cc of propofol had a recovery time 2.90 minutes longer than those that of patients received 7-12 cc of propofol (p<0.001, Bonferroni-corrected p=0.005). These results suggest that receiving high doses of midazolam and having a history of stroke are associated with longer recovery times. Patients meeting these criteria should be managed carefully after sedation for upper gastrointestinal endoscopy.

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

Cited by 5 publications

References 36 publications

Combination of propofol and nasal sufentanil or intravenous midazolam for colonoscopy: a comparative study

Combination of propofol and nasal sufentanil or intravenous midazolam for colonoscopy: a comparative study

Efficacy and Safety of Remimazolam in Endoscopic Sedation—A Systematic Review and Meta-Analysis

Factors Affecting Recovery Time after Sedation for Upper Gastrointestinal Endoscopy

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