Sedation for Fibreoptic Gastroscopy: A Comparative Study of Midazolam and Diazepam

Abstract

Midazolam, a water-soluble benzodiazepine, was compared with diazepam in fat emulsion (Diazemuls) as sedation for outpatient gastroscopy in a randomized double-blind fashion. Midazolam 0.05 mg kg-1 was found to be approximately equipotent to Diazemuls 0.15 mg kg-1. There were no differences concerning speed of recovery and all patients were considered ready for discharge after 2 h. Venous tolerance was good for both drugs. With the same degree of sedation, midazolam produced a higher frequency of amnesia (60% v. 7%; P less than 0.001) for the endoscopic procedure. Although the patients appeared to prefer midazolam to Diazemuls, this difference was significant only in patients who had not previously undergone gastroscopy (P less than 0.05). The high degree of amnesia with midazolam may be an advantage in sedation for unpleasant procedures like gastroscopy.

Respiratory and cardiovascular effects in relation to plasma levels of midazolam and diazepam.

“…These changes point towards acute tolerance development. Since the doses of diazepam and midazolam were equipotent in regard of sedation (Berggren et al, 1983), the difference in the blood pressure changes between the drugs was not supposed to be related to the degree of sedation. Klotz et al (1980) concludes that the large number of different pharmacological effects, and also the number of active metabolites formed by diazepam complicates the interpretation of Cpeffect data.…”

“…The doses were equipotent with regard to sedation (Berggren et al, 1983). Due to the different appearances of the drugs, a double-dummy approach was used.…”

“…administration. Midazolam also has a rapid elimination (tl½,Z = 1.7-2.6 h) compared with the 24-57 h half-life of diazepam, which may shorten the duration of the residual effects when used preoperatively (Berggren et al, 1983).…”

Sedation for gastroscopy: a comparative study of midazolam and Diazemuls in patients with and without cirrhosis.

“…Using smaller doses might lead to less sedation as well as shorter recovery time. This is indeed suggested by Berggren et al (1983) following the use of the smaller dose of 0.05 mg kg-' but it may well also lead to a loss of some of the amnesic effect.…”

“…The problem is even greater in patients with liver disease where examination and injection of oesophageal varices using fibre-optic endoscopy is becoming an increasingly common procedure. The new watersoluble compound midazolam has been widely recommended as a sedative as it has been reported to be associated with a faster onset of sedation, greater degree of amnesia and faster rate of recovery (Al-Kudhairi et al, 1982;Brophy et al, 1982;Berggren et al, 1983;Whitwam et al, 1983;Bardhan et al, 1984).…”