The comparison of midazolam and topical lidocaine spray versus the combination of midazolam, meperidine, and topical lidocaine spray to sedate patients for upper endoscopy

Guidelines for Conscious Sedation and Monitoring During Gastrointestinal Endoscopy

“…21 Another report suggested that the addition of meperidine to midazolam was favored by endoscopists compared with midazolam alone for upper endoscopy, but added no benefit from the patient's viewpoint. 22 Specific antagonists of opiates (naloxone) and benzodiazepines (flumazenil) are available and should be present in every endoscopy unit to treat over-sedated patients.…”

Meperidine as the single sedative agent during esophagogastroduodenoscopy, a double‐blind, randomized, controlled study

“…11 In contrast, Laluna et al showed that the addition of meperidine to midazolam in patients undergoing EGD adds no benefit from the patients' viewpoint, although fewer retching episodes were noted. 10 The study, however, involved small number (~50/group) of patients, and the result is at risk of a type II error. Midazolam has sedative and amnesic effects, so patients may suffer from discomfort during the procedure but do not remember later.…”

“…The impact of meperidine as a single agent in EGD remains controversial. 10,11 A brief report showed that the use of meperidine as a single sedative agent for EGD was not beneficial in reducing retching and agitation. 12 In contrast, another study showed that fentanyl, an opiate similar to meperidine, was helpful in improving patient tolerance and attenuated the endoscopy-induced rise in rate-pressure product and serum cortisol concentration.…”

Pethidine hydrochloride is a better sedation method for pharyngeal observation by transoral endoscopy compared with no sedation and midazolam

“…First, it has been reported to reduce the gag and cough reflexes. 22,29 The gag reflex is induced by touching the base of the tongue, soft palate, uvula or Figure 3 Total score for the seven sites in the five pharyngeal regions evaluated by the endoscopists who carried out the procedures. The score was significantly different (P < 0.0001; Kruskal-Wallis test), being significantly higher in the pethidine hydrochloride group than in the no sedation (P = 0.0001; Mann-Whitney U-test) and midazolam (P < 0.0001; Mann-Whitney U-test) groups.…”