A Randomized Comparison of Midazolam and Diazepam for Sedation in Upper Gastrointestinal Endoscopy

Magni, V. C.; Frost, Robert A.; Leung, Joseph; Cotton, P. B.

doi:10.1093/bja/55.11.1095

Cited by 72 publications

(19 citation statements)

References 16 publications

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“…Recovery was similar in both the groups: Judged clinically, most patients had recovered, but their performance in Trieger testing significantly impaired at 4h after the administration of the drugs. This is consistent with published evidence for both the drugs [4,6]. Impaired cognitive response with diazepam and midazolam may be related to metabolites [7].…”

Section: Discussionsupporting

confidence: 92%

Midazolam, a New More Potent Benzodiazepine, Compared With Diazepam as Sedative During Spinal Analgesia, a Randomised Double Blind Study

Suri

Lamba

2000

Medical Journal Armed Forces India

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Midazolam, a new benzodiazepine was compared with diazepam as intraoperative sedative during spinal anaesthesia in a double blind study. Eighty five patients participated in this clinical trial (placebo 25, midazolam 30, diazepam 30). Drug treatment was administered after spinal anaesthesia at 5 min of supine position. Level of spinal anaesthesia in terms of sympathetic blocade was similar in aU the patients. Dosage of drug were tailored to the needs of each patient till the end point of undisturbed sleep. Intraoperative sedation based on predetermined criteria, recovery by Trieger's test at 4 hr after the drug administration, antegrade amnesia by memory card and haemodynamics were assessed. Mean doses of 240 Ilg kg-! and 500 Ilg kg-Iof midazolam and diazepam were required to induce sleep which suggest an equivalent dose ratio of midazolam: diazepam as 1: 2.1. Both the drugs produced effective sedation during spinal anaesthesia, 86.6% patient with midazolam and 93.3% patients with diazepam had deep undisturbed sleep. Clinical recovery was fast in midazolam administered patients but did not meet the criteria of early discharge by Trieger's test at 4 hr after the administration of the drug. There were no gross changes in the circulatory effects of the two drugs. Decrease in mean systolic pressure (<10%) and marginal increase in heart rate was seen. The frequency of antegrade amnesia was greater with midazolam. Global assessment as judged by anaesthesiologist and patients satisfaction for anaesthesia and recovery was higher (93.3%) with midazolam as compared to (79.9%) diazepam. Trieger test consists of a series of dots arranged in a simple pattern which the patient connects as accurately as possible. The accuracy and timings were compared with the baseline test carried out before premedication. Decrease in accuracy was measured by recording the number of dots missed and the cumulative distance of miss in mm, compared with the baseline test. Position of the patient, moderator staff, place, material and light were the same during performance of the test.Patients were premedicated with injection atropine 0.6 mg and injection fortwin 0.5 mg kg -I intramuscularly one hour prior to surgery in the anaesthetic room and iv cannula was placed on the dorsum of the hand; heart rate, arterial pressure, level of sedation were recorded.Lumbar puncture was performed in the sitting position at the 3rd interspace and 0.5% plain bupivacaine 4 ml was injected at 1 mi. 5 Sec -I. The patients were returned to the supine position, heart rate, blood pressure and upper level of block (pinprick test of analgesia) were recorded every 5 min until spread ceased. Respiratory rate was also recorded. Drug (placebo, midazolam and diaze-

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Section: Discussionsupporting

confidence: 92%

Midazolam, a New More Potent Benzodiazepine, Compared With Diazepam as Sedative During Spinal Analgesia, a Randomised Double Blind Study

Suri

Lamba

2000

Medical Journal Armed Forces India

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“…Psychomotor performance, measured using the Trieger test, was equally impaired by either drug for up to two hours after sedation. 17 Neither the present study nor any of the studies reviewed have shown a clear advantage in safety or more rapid recovery when midazolam is compared with diazepam. In two surveys 11,12 of endoscopic practice, patient morbidity was reported equally frequently with either drug.…”

Section: Discussioncontrasting

confidence: 66%

Sedation for upper gastrointestinal endoscopy: a comparison of alfentanil-midazolam and meperidine-diazepam

1994

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The authors studied the efficacy and cost of substituting sedation using midazolam and alfentanil for the existing regimen of diazepam and meperidine in patients requiring upper gastrointestinal endoscopy. Sixty consenting subjects were randomized to receive either meperidine 50 mg with diazepam approximately 90 #g" kg -1 (Group 19) (0,4 + 0,6 vs 1,7 • 2,4, P < 0,005) Les auteurs comparent I'efficacit~ et le coCtt de la substitution du midazolam et de l'alfentanil utilis~s pour la s~dation it l'association courante de diazepam et de m~p~ridine chez des patients soumis it un endoscopie gastro-intestinale haute. Soixante aduhes consentants sont r~partis au hasard pour recevoir soit mdpdridine 50 mg avec diazepam 90 ~g" kg -t environ (groupe D) soit alfentanil 250 t~g avec 50 ~tg" kg -t environ de midazolam (groupe M). La temps requis pour d~ntroduction de

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“…Studies of its use for sedation during EGD have suggested that it is more potent, faster acting, and provides greater amnesia and patient acceptance of the procedure than diazepam [10][11][12][13][14][15][16]. However, experience with midazolam in children has been largely limited to use as an induction agent for gen eral anesthesia [17,18].…”

mentioning

confidence: 99%

Randomized, Double-Blind Trial of Midazolam and Diazepam for Endoscopic Sedation in Children

Tolia

Fleming

Kauffman³

1990

Dev Pharmacol Ther

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We performed a prospective, randomized, double-blind study of 41 children (6-18 years of age) who were undergoing esophagogastroduodenoscopy (EGD) to compare the efficacy of diazepam and midazolam with respect to quality of sedation and amnesia. The endoscopist assessed the patients for control of salivation, gag reflex, vomiting and cooperation after intravenous injection of either 0.1-0.15 mg/kg of midazolam or 0.2-0.4 mg/kg of diazepam. The patients answered a questionnaire at 1 and 24 h after the procedure to assess recall of procedure details, pain and/or discomfort, and their medication choice for future procedures. Vital signs were monitored for 1 h after injection. Although midazolam caused greater mean maximum increase in heart rate than diazepam (30 vs. 14/min), no difference was found between the two treatment groups with respect to other vital signs. There was also no difference in physician’s assessment or patient recall of specific events during the procedure. However, significantly fewer patients recalled pain or discomfort with midazolam at both 1 and 24 h following the procedure (p = 0.02). In addition, more patients receiving midazolam indicated preference for the same sedation for future procedures. We conclude that midazolam may provide better amnesia in children undergoing endoscopic procedures.

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A Randomized Comparison of Midazolam and Diazepam for Sedation in Upper Gastrointestinal Endoscopy

Cited by 72 publications

References 16 publications

Midazolam, a New More Potent Benzodiazepine, Compared With Diazepam as Sedative During Spinal Analgesia, a Randomised Double Blind Study

Midazolam, a New More Potent Benzodiazepine, Compared With Diazepam as Sedative During Spinal Analgesia, a Randomised Double Blind Study

Sedation for upper gastrointestinal endoscopy: a comparison of alfentanil-midazolam and meperidine-diazepam

Randomized, Double-Blind Trial of Midazolam and Diazepam for Endoscopic Sedation in Children

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