The Influence of Adding Diphenhydramine Before Initiation of Moderate Sedation with Midazolam and Pethidine for Improving Quality of Colonoscopy

Shahawy, Mohamed S El; EL-Fayoumy, Mohamed

doi:10.1016/j.jnma.2019.09.001

Cited by 5 publications

(7 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Establishing an optimal regimen Frontiers in Pharmacology frontiersin.org contributes to safe and efficient endoscopic operations. The American Society of Gastrointestinal Endoscopy (ASGE) and Canadian Association of Gastroenterologists (CAG) have noted that the combination of benzodiazepines and opioids is adequate for conventional digestive endoscopy, particularly when applied for the induction of moderate sedation and analgesia during colonoscopy (Keeffe, 1995;Byrne et al, 2008;Early et al, 2018;El Shahawy and El-Fayoumy, 2019). Based on systematic evaluations of cohort studies, midazolam is recommended by both the GSGMD and the SSGE as a benzodiazepine drug preferred for the induction of sedation (Igea et al, 2014;Riphaus et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

“…Appropriate sedation can help alleviate discomfort during endoscopy, thus improving the tolerance of and acceptance by patients and increasing the success rate of examinations. In contrast, poor sedation may cause insufficient cooperation by patients or fear resulting from stress-related discomfort or injury, leading to poor satisfaction and compliance ( El Shahawy and El-Fayoumy, 2019 ). Because the requirements for comfort during digestive endoscopy have increased, sedation quality has become a principal indicator for measuring satisfaction, and patient satisfaction with the procedure directly reflects the sedative effect and sedative quality ( Kilgert et al, 2014 ).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy and safety of midazolam combined with dezocine for sedation and analgesia in digestive endoscopy: A prospective open single-center study

Chen

Sun²,

Lu³

et al. 2022

Front. Pharmacol.

View full text Add to dashboard Cite

Objective: Digestive endoscopy is an important means of diagnosing and treating gastrointestinal diseases and a tool for screening and monitoring early gastrointestinal tumors. Digestive endoscopy can be performed using midazolam combined with dezocine for sedation and analgesia. This study explored the efficacy and safety of midazolam combined with dezocine.Methods: A total of 135 patients undergoing digestive endoscopy in the Department of Gastrointestinal Endoscopy of the Sixth Affiliated Hospital, Sun Yat-sen University, from June 2021 to September 2021, were enrolled and non-blindly and non-randomly divided into a sedation-endoscopy-group (SEG, n = 45), anesthesia-endoscopy-group (AEG, n = 44), and ordinary-endoscopy-group (OEG, n = 46). Vital signs, levels of sedation and analgesia, the degree of pain during colonoscopy, satisfaction, and the incidence of complications were compared among the three groups.Results: There were no statistically significant differences in vital signs (blood pressure, pulse, respiration, and blood oxygen saturation) among the three groups before endoscopy (p > 0.05). The AEG reported no pain during colonoscopy, and the pain score during colonoscopy for the SEG was lower than that for the OEG (1.11 ± 1.21 vs. 3.00 ± 1.16, p < 0.001). The scores for satisfaction were 8.84 ± 1.30 points in the SEG, 8.95 ± 1.10 points in the AEG, and 6.37 ± 0.90 points in the OEG; the differences were statistically significant (p < 0.001). The total incidence of complications in the AEG was 38.64% (17/44), which was significantly higher than that in the SEG [13.33% (6/45)] and OEG [13.04% (6/46)] (p < 0.001). In the SEG, the overall incidence of complications in women was significantly higher than that in men (p = 0.027).Conclusion: Digestive endoscopy using midazolam combined with dezocine for sedation makes patients more comfortable, more satisfied and more compliant than the ordinary endoscopy. Additionally, it is comparable to endoscopy under general anesthesia with propofol with regard to comfort, satisfaction, and patient compliance and comparable to the ordinary endoscopy with regard to safety. Considering the shortage of anesthesiologists, the application of midazolam combined with dezocine in digestive endoscopy is worthy of clinical popularization. This study has been registered in the Hospital Ethics Committee of the Sun Yat-sen University Sixth Affiliated Hospital (Ethical Number: 2021ZSLYEC-182).

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of midazolam combined with dezocine for sedation and analgesia in digestive endoscopy: A prospective open single-center study

Chen

Sun²,

Lu³

et al. 2022

Front. Pharmacol.

View full text Add to dashboard Cite

show abstract

“…The American Society of Gastrointestinal Endoscopy (ASGE) and the Canadian Association of Gastroenterology (CAG) noted that the combined use of benzodiazepines and opioids is sufficient for inducing sedation and analgesia for gastrointestinal endoscopy, especially for inducing moderate sedation and analgesia during colonoscopy ( Byrne et al, 2008 ; Early et al, 2018 ; El Shahawy and El-Fayoumy, 2019 ). According to both GSGMD and SSGE, midazolam is recommended as the first choice benzodiazepine for inducing sedation ( Igea et al, 2014 ; Riphaus et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

“…Moderate sedation can relieve discomfort during colonoscopy and improve the patient’s tolerance and acceptance and the success rate of the examination. In contrast, insufficient sedation may cause discomfort and pain in patients, resulting in fear of colonoscopy and poor satisfaction and compliance ( El Shahawy and El-Fayoumy, 2019 ). The comfort requirements during colonoscopy are high, and the quality of sedation is the main indicator of satisfaction.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety analysis of midazolam combined with dezocine sedation and analgesia colonoscopy in patients with inflammatory bowel disease: a prospective single-center open study

Chen

Xiang

et al. 2023

Front. Pharmacol.

View full text Add to dashboard Cite

Objective: Colonoscopy plays an important role in the diagnosis, prognosis prediction, assessment of disease activity and severity, and treatment of inflammatory bowel disease (IBD)-related complications. However, some patients refuse to undergo colonoscopy due to perceived pain and other discomfort, their diagnosis and treatment are affected. Therefore, we conducted a prospective study to explore the efficacy and safety of midazolam combined with dezocine for sedation in IBD patients undergoing colonoscopy.Methods: 224 patients were divided into sedative-colonoscopy-group (SCG, n = 93), anesthesia-colonoscopy-group (ACG, n = 90) and ordinary-colonoscopy-group (OCG, n = 41). The vital signs (blood pressure, pulse, respiration and blood oxygen saturation), pain degree during colonoscopy, satisfaction and complication rates of the three groups were compared.Results: Before colonoscopy, there was no significant difference among the vital signs of the three groups. The vital signs of the ACG were significantly lower than those of the SEG and the OCG (p < 0.05), and the difference was not significant between the SCG and OCG during colonoscopy. The colonoscopy pain score in the SCG was lower than that in the OCG (0.79 ± 1.09 vs. 2.98 ± 1.27, p < 0.001). The satisfaction score of the SCG (9.26 ± 1.16) was not significantly different from that of the ACG (9.42 ± 1.41) but was higher than that of the OCG (6.63 ± 1.13) (p < 0.001). The total complication rate of the ACG was 45.56% (41/90), which was significantly higher than that of the SCG [20.43% (19/93)] and the OCG [19.51% (8/41)]. Colon perforation, abnormal blood pressure fluctuation and hypoxemia were significantly more common in the ACG than in the SCG and the OCG (p < 0.05). However, there was no significant difference in the incidence of complications between the SCG and OCG.Conclusion: Compared with ordinary-colonoscopy, colonoscopy performed under midazolam and dezocine sedation is more comfortable for patients, thereby increasing satisfaction and compliance. Colonoscopy that is performed under midazolam and dezocine is similar to colonoscopy that is anesthesia with propofol in terms of comfort, satisfaction and compliance and similar to ordinary-colonoscopy in terms of safety. Considering the shortage of anesthesiologists, the application of midazolam combined with dezocine for digestive endoscopy is worthy of clinical promotion.

show abstract

“…However, some patients cannot get enough sedation with the typical benzodiazepine and opioid combination; in these cases, the addition of diphenhydramine is advised by current recommendations since it "may allow adequate and safe sedation to be achieved". Furthermore, a number of studies have demonstrated that administering intravenous diphenhydramine hydrochloride prior to the administration of midazolam significantly improves the level of mild sedation experienced during colonoscopy procedures while reducing sedativerelated problems [5] .…”

Section: Introductionmentioning

confidence: 99%

Study of Adding Pheniramine to Midazolam on Sedation during Colonoscopy in Tanta University Hospital: A Comparative Study

2023

The Egyptian Journal of Hospital Medicine

View full text Add to dashboard Cite

Background: The whole big bowel may be seen inspected during a colonoscopy. The gold standard for the early identification of polyps and colorectal cancer, it is safe and reliable. The most often used drugs for moderate sedation are midazolam and fentanyl, which are benzodiazepines or mixtures of benzodiazepines and opioids. Objective: The aim of the current study was to assess the safety and viability of midazolam with that of midazolam/pheniramine in sedation of patients undergoing colonoscopy. Patients and methods: This clinical trial was carried out on 90 patients indicated for colonoscopy. Patients were randomized into 2 equal groups: Group A was sedated using midazolam (Dormicum) 5mg given slowly intravenously over one minute, and Group B was sedated using phinarimine 25mg (Avil) ampule given slowly intravenously 5 minutes before the procedure, then midazolam 5mg given slowly intravenously over one minute. Results: There was a significant delay in time for initiation of sedation, and procedure time in Group A. But there was a significant delay in the post-procedure time and recovery time in Group B. There was a significant increase in satisfaction scale, endoscopist's satisfaction in patients of Group B. Conclusion: Use of intravenous pheniramine maleate given before initiation of midazolam is superior to using midazolam alone in the decrease of preprocedural's anxiety, quality improvement for moderate sedation during colonoscopy, high satisfaction score for the patients, high tolerance to the procedure and higher endoscopes' satisfaction during the procedure.

show abstract

The Influence of Adding Diphenhydramine Before Initiation of Moderate Sedation with Midazolam and Pethidine for Improving Quality of Colonoscopy

Cited by 5 publications

References 15 publications

Efficacy and safety of midazolam combined with dezocine for sedation and analgesia in digestive endoscopy: A prospective open single-center study

Efficacy and safety of midazolam combined with dezocine for sedation and analgesia in digestive endoscopy: A prospective open single-center study

Efficacy and safety analysis of midazolam combined with dezocine sedation and analgesia colonoscopy in patients with inflammatory bowel disease: a prospective single-center open study

Study of Adding Pheniramine to Midazolam on Sedation during Colonoscopy in Tanta University Hospital: A Comparative Study

Contact Info

Product

Resources

About