A comparison of diazepam and midazolam as endoscopy premedication assessing changes in ventilation and oxygen saturation.

Abstract

1 One hundred and two consecutive patients undergoing upper gastrointestinal endoscopy were randomised to be sedated with either intravenous diazepam (Diazemuls-Kabi Vitrum) or intravenous midazolam (Hypnovel-Roche). It was assumed that midazolam was likely to be approximately twice as potent as diazepam on the basis of previous work. 2 All patients had an ear oximeter attached throughout the procedure to record continuously their level of oxygen saturation. 3 All 102 patients had pre-endoscopy respiratory function tests measured and 100 wore an induction plethysmograph vest to allow continuous estimation of respiratory rate and excursion. The plethysmograph was calibrated using a pneumotachygraph, so baseline, post-injection and post-endoscopy minute volumes could be estimated. 4 The age, sex ratio and pre-endoscopy respiratory function tests of the 51 patients given intravenous diazepam in a mean dose (s.d.) of 11.5 (5.8) mg over a mean of 3.4 (0.9) min) were similar to that of the 51 patients sedated with intravenous midazolam (mean dose 6.0 (2.8) mg over 3.3 (0.9) min. 5 Both drugs significantly reduced minute volume (P < 0.001) and oxygen saturation (P < 0.001). Midazolam appeared to produce slightly greater hypoxaemia with 57% having falls in oxygen saturation of greater than 2.5% compared with only 35% given an equivalent dose of diazepam. 6 Ventilation was still less than baseline when re-checked some minutes after removal of the gastroscope. The speed of recovery appeared faster after diazepam sedation which is in contrast to its longer pharmacological half-life. 7 Potentially dangerous falls in oxygen saturation were observed in five cases (three following diazepam and two midazolam), necessitating supplementary oxygen administration. The implications of these findings are discussed.

How does tolerability of double balloon enteroscopy compare to other forms of endoscopy?

“…Significantly higher doses of analgesia were also required, potentiating the risks posed by the sedation. Thus, patients undergoing DBE may be at increased risk of hypotension, respiratory depression and even cardiorespiratory arrest 16 17…”

Guidelines for sedation in gastroenterological endoscopy

“…The RCT comparing the unsedated group and the midazolam‐alone or diazepam‐alone group showed that midazolam alone was more effective than diazepam alone in improving patient satisfaction and decreasing phlebitis . Six RCTs have directly compared midazolam and diazepam, and satisfaction for both patients and endoscopists was comparable between the two groups . Meanwhile, requesting the use of the same sedative and memory loss (the amnesia effect) during the examination were more frequently observed in the midazolam group than in the diazepam group.…”

“…34 Six RCTs have directly compared midazolam and diazepam, and satisfaction for both patients and endoscopists was comparable between the two groups. [38][39][40][41][42][43] Meanwhile, requesting the use of the same sedative and memory loss (the amnesia effect) during the examination were more frequently observed in the midazolam group than in the diazepam group. Although there were no significant differences in adverse effects such as cardiorespiratory depression between the two groups, venous irritation (phlebitis) occurred significantly less frequently in the midazolam group than in the diazepam group.…”

More than half of hypoxemia cases occurred during the recovery period after completion of esophagogastroduodenoscopy with planned moderate sedation

“…The sedative used in most procedures in the present study was diazepam. Many randomized, controlled trials (RCTs) [8][9][10][11][12] have demonstrated that there is no difference in side effects such as cardiorespiratory depression between diazepam and midazolam when used during EGD procedures. When the recovery times of diazepam and midazolam were compared, midazolam was found to have a faster recovery 10 .…”