Sedation for upper gastrointestinal endoscopy: a comparative study of midazolam and diazepam

We conducted a randomized, double-blind trial evaluating the efficacy and safety of meperidine 2 mg.kg-1 (M) and meperidine 2 mg.kg-1 plus midazolam 0.05 mg.kg-1 (M + M) in 40 pediatric outpatients (age 1 to 17 years) undergoing upper endoscopy procedures. The physician and nurse performing the procedure were asked to rate cooperation, emotional status, drowsiness, and overall efficacy. A blinded observer recorded the frequency of negative behaviors indicating distress, vital signs, and oxygen saturation before, during, and after the procedure. No significant differences were noted in the overall efficacy of the regimens. Good or excellent efficacy was noted in 15 of 21 children (71%) in the M group and 15 of 19 children (79%) in the M + M group by physicians; nurses assigned a good or excellent rating for 14 of 21 (67%) and 13 of 19 (68%) in the M and M + M groups, respectively. Immediately following the procedure, amnesia was noted in 4 of 17 (23%) patients who received M versus 14 of 18 (78%) patients who received M + M (P = 0.002). Of the children who received M + M, the amnesia tended to occur more frequently in older children (> 11 years, 8 children, rate of amnesia 100%) than in younger children (< or = 11 years, 6 of 10 evaluable children, rate of amnesia 60%). There was no significant difference between the frequency of negative behaviors, rate of adverse effects, or changes in vital signs or oxygen saturation noted with the two drug regimens.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…Midazolam has recently gained widespread use and is now considered by some as the premedication of choice in adults [10][11][12][13].…”

Section: Discussionmentioning

confidence: 99%

“…Upon further investigation, it was determined that elderly require smaller doses, and midazolam can be used safely at appropriate doses [7][8][9]. Consequently, midazolam has gained widespread use in adult patients undergoing endoscopy procedures [10][11][12][13]. Information regarding the use of midazolam as a premedication in children is lacking.…”

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confidence: 99%

Sedation with meperidine and midazolam in pediatric patients undergoing endoscopy

Bahal-O'Mara

Nahata

Murray

et al. 1994

Eur J Clin Pharmacol

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“…Benzodiazepines are the most commonly used sedatives; opi− ates have been used much less frequently in recent years due to the high rate of respiratory complications. Midozalam is a sedative that was specially developed for short procedures [7]; besides sedation, it provides antegrade amnesia, a desirable effect that means that the unpleasant sensations per− ceived by the patient during endoscopy tend to recede. Its use does, however, require that special attention is paid to the out− patients who receive it, especially with regard to the provision of patient information and patient handling after endoscopy (see below).…”

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confidence: 99%

Austrian Society of Gastroenterology and Hepatology (ÖGGH) - Guidelines on sedation and monitoring during gastrointestinal endoscopy

Schreiber¹

2007

Endoscopy

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“…midazolam was more effective than diazepam on improvement of patient satisfaction and on reduction of phlebitis. 28 Because midazolam has an amnesic effect, it is necessary to notice whether a patient may not remember explanations given by the physician just after an examination. 29 A meta-analysis showed both propofol and midazolam improve patient satisfaction and willingness to repeat EGD, 30 but propofol is advantageous for short sedation and recovery times compared to midazolam.…”

Section: Sedationmentioning

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

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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...

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Sedation for upper gastrointestinal endoscopy: a comparative study of midazolam and diazepam

Cited by 54 publications

References 11 publications

Sedation with meperidine and midazolam in pediatric patients undergoing endoscopy

Sedation with meperidine and midazolam in pediatric patients undergoing endoscopy

Austrian Society of Gastroenterology and Hepatology (ÖGGH) - Guidelines on sedation and monitoring during gastrointestinal endoscopy

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

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