Midazolam for sedation during diagnostic or therapeutic upper gastrointestinal endoscopy in cirrhotic patients

Haq, Muhammad Mansoor ul; Faisal, Nabiha; Khalil, Ayesha; Haqqi, Syed Afzal; Shaikh, Hafeezullah; Arain, Nazim

doi:10.1097/meg.0b013e328356ae49

Cited by 23 publications

(24 citation statements)

References 17 publications

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“…Interestingly, overt HEP after EVL under sedation developed only in 0.4% of patients, which is a lower incidence than that reported in a previous study [12] . We believe that this outcome may be due to the use of flumazenil to reverse the sedative effect of midazolam.…”

Section: Discussioncontrasting

confidence: 48%

“…However, it is a short-acting benzodiazepine, and flumazenil is a rapidly-acting midazolam antidote [4][5][6][7] . In a previous study, it was reported that intravenous midazolam can be considered safe in patients with compensated LC [12] . However, this previous study was limited by the use of retrospective data; 4.2% of the enrolled patients had previous experience of overt HEP, and patients administered flumazenil were excluded.…”

Section: Introductionmentioning

confidence: 99%

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Conscious Sedation Using Midazolam and Sequential Flumazenil in Cirrhotic Patients for Prophylactic Endoscopic Variceal Ligation

Kim

Jin²,

Lee³

et al. 2015

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Background/Aims: This study investigated the safety of endoscopic variceal ligation (EVL) under conscious sedation with midazolam and sequential flumazenil after procedure in these patients. Methods: A total of 279 patients who underwent secondary prophylactic EVL at our institution between April 2012 and June 2014, were enrolled. Conscious sedation was achieved using intravenous midazolam, and flumazenil was routinely used as an antidote immediately after EVL. Patients with sleep (n = 165) and non-sleep (n = 55) endoscopy were matched using propensity score analysis (3:1). Frequencies of overt hepatic encephalopathy (HEP) and patient' satisfactions with EVL were compared between the 2 groups. Results: Of the 279 patients, 155 (55.6%) were of Child-Turcotte-Pugh (CTP) class, B or C, and 224 (80.3%) patients underwent sleep endoscopy. After propensity score analysis, overt HEP was observed in 1 (0.4%) of the 165 patients in the sedated group, but not found in any in the non-sedated group. Patient' satisfaction with EVL was better in the sedated group (p < 0.001). Twenty-nine (65.9%) of the 44 patients with CTP class C underwent sleep endoscopy, and only one (3.4%) experienced overt HEP. Conclusions: Prophylactic EVL under conscious sedation using midazolam and flumazenil is probably safe in cirrhotic patients without experience of HEP, even in those of CTP class C.

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Section: Discussioncontrasting

confidence: 48%

Section: Introductionmentioning

confidence: 99%

Conscious Sedation Using Midazolam and Sequential Flumazenil in Cirrhotic Patients for Prophylactic Endoscopic Variceal Ligation

Kim

Jin²,

Lee³

et al. 2015

Digestion

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“…24 Dexmedetomidine and midazolam were used in the present study because these drugs have distinctive pharmacological profiles and their respective adverse effects require different management strategies. 10,18,19 Dexmedetomidine is commonly administered as a bolus of 0.5-1.0 mg/kg, followed by an infusion of 0.2-2.0 mg/kg per h. The initial loading dose may cause adverse cardiovascular reactions such as hypertension, hypotension, bradycardia or sinus arrest, especially in patients taking medication capable of producing negative chronotropic effects (e.g. b-adrenergic antagonists and digoxin) or those with hypovolaemia.…”

Section: Discussionmentioning

confidence: 99%

“…10 Midazolam was selected as the medication for comparison in our study owing to its frequent use as a sedative in gastroscopy and endoscopy. 10,18,19 Midazolam is usually used alone for gastroscopy and is combined with opioids (meperidine or fentanyl) for colonoscopy and endoscopic retrograde cholangiopancreatography (ERCP). 10,23 Some studies have recommended propofol as a sedative in upper gastrointestinal endoscopy, but difficulties in estimating the correct dosage and the lack of a direct antagonist limit its use, particularly in high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine versus midazolam for sedation in upper gastrointestinal endoscopy

Chen

Zhang

et al. 2014

J Int Med Res

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Objectives: To investigate the efficacy and safety of sedation with dexmedetomidine in upper gastrointestinal endoscopy. Methods: Patients with ASA physical status I-II undergoing elective upper gastrointestinal endoscopy were randomly allocated to receive dexmedetomidine or midazolam for conscious sedation. Continuous peripheral oxygen saturation (SpO 2 ), heart rate, mean arterial pressure (MAP), Ramsay Sedation Scale (RSS) and numeric rating scale pain scores were recorded before, during and after the procedure. Patients completed a post-procedure satisfaction questionnaire. Results: Patients in the midazolam group (n ¼ 30) experienced a significant decrease in MAP during sedation compared with pre-sedation values. Patients in the dexmedetomidine group (n ¼ 30) had significantly higher SpO 2 and RSS scores during sedation than those in the midazolam group. Overall satisfaction was higher in the dexmedetomidine group than the midazolam group. There were no clinically significant complications in either group. Conclusion: Dexmedetomidine has a good safety profile and is an effective sedative for use in upper gastrointestinal endoscopy.

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“…It was suggested that greater central nervous sensitivity to intravenous anesthetics was affected in certain ways by liver dysfunction, such as by progressive cognitive dysfunction or slowing of brain activity (31). Hepatic dysfunction has already been demonstrated to enhance sensitivity to sedative agents (32). Therefore, it was suggested that the exact dose of propofol, administered by TCI for appropriate depth of anesthesia in patients with severe impaired liver function, requires further investigation.…”

Section: Discussionmentioning

confidence: 99%

Pharmacodynamic analysis of target-controlled infusion of propofol in patients with hepatic insufficiency

et al. 2016

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Abstract. The effect of liver dysfunction on target-controlled infusion (TCI) of propofol remains poorly documented. The pharmacodynamic performance of propofol TCI was evaluated in a cohort of Chinese patients with hepatic insufficiency. Fifty-three patients with hepatic insufficiency were enrolled in the current prospective, observational study. Anesthesia was induced with propofol via TCI to a plasma concentration of 3 µg/ml. Following loss of consciousness (LOC), fentanyl and cisatracurium were administered. Pharmacodynamic parameters were recorded during TCI, including time to LOC, bispectral index (BIS), heart rate (HR) and blood pressure. Patients were divided into two groups based on model of end stage liver disease (MELD) score: Those with a MELD score of ≤9 and those with a MELD score of ≥10. BIS, mean arterial pressure and HR were demonstrated to vary according to time, but were not affected by liver dysfunction. Hypotension was prominent in patients with a MELD score of ≥10 30 min after induction. The proportion of bradycardia and hypotension at the other time points was not significantly different between MELD scores of ≤9 and ≥10. Notably, no bradycardia was observed in MELD of ≥10. Thus, bradycardia and hypotension was observed in patients with hepatic insufficiency over time, although patients with different severities of hepatic insufficiency did not present with different depths of anesthesia. TCI of propofol to 3 µg/ml may be not suitable for patients with hepatic insufficiency, particularly those with severe liver dysfunction. Predictive concentrations (Cp) of TCI propofol requires further investigation and adjustment in patients with hepatic insufficiency (trial registration no. ChiCTR-OCH-12002255).

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Midazolam for sedation during diagnostic or therapeutic upper gastrointestinal endoscopy in cirrhotic patients

Abstract: We concluded that intravenous midazolam can be used safely in cirrhotic patients of Child-Pugh class A and B undergoing UGE for conscious sedation, but caution should be exercised for patients with advanced liver disease.

Cited by 23 publications

References 17 publications

Conscious Sedation Using Midazolam and Sequential Flumazenil in Cirrhotic Patients for Prophylactic Endoscopic Variceal Ligation

Conscious Sedation Using Midazolam and Sequential Flumazenil in Cirrhotic Patients for Prophylactic Endoscopic Variceal Ligation

Dexmedetomidine versus midazolam for sedation in upper gastrointestinal endoscopy

Pharmacodynamic analysis of target-controlled infusion of propofol in patients with hepatic insufficiency

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