Sedation With Intranasal Midazolam in Adults Undergoing Upper Gastrointestinal Endoscopy

Abstract

The use of intranasal (IN) midazolam in adults for sedation in upper gastrointestinal endoscopy has been evaluated in a controlled clinical study. Eighty-one patients with a mean age of 37.02 +/- 12.50 years who underwent upper gastrointestinal endoscopy for various reasons were included in the study. Three groups were formed according to the sedation regimen. In the first group (n = 30), patients received IN midazolam. In the second group (n = 28) intravenous (IV) midazolam was given for sedation, and the third group of patients (n = 23) received placebo before the procedures. Patients were monitored (using a pulse oximeter with an interval of 5 minutes until the 45th minute after the procedure) for arterial oxygen saturation, heart rate, systolic and diastolic arterial blood pressure, and respiratory rate. Efficacy of sedation, amnesia, side effects, and patients' preferences were evaluated. Superior results regarding the efficacy of sedation has been documented with the use of IV midazolam (p< 0.001), and this was the preferred route for drug application according to the patients' answers (p < 0.01). However, regarding amnesia, IN midazolam was found to be almost equally effective as IV midazolam (p < 0.05); moreover, IN route of drug application caused significantly fewer side effects than did the IV form (p < 0.001 ). Intranasal application of midazolam for gastrointestinal endoscopy appeared to be an interesting alternative to the IV route, the usage of which might be limited because of its potentially serious side effects. In contrast to the IV application of midazolam, the IN route may not even necessitate the monitoring of the patient during upper gastrointestinal endoscopy.

Identification of Factors that Influence Conscious Sedation in Gastrointestinal Endoscopy

“…Although propofol provides faster onset and deeper sedation than standard benzodiazepines, clinically important benefits have not been consistently demonstrated in average-risk patients undergoing standard upper and lower gastrointestinal endoscopy (2). Besides, intravenous midazolam has been proven to give the best results in gastrointestinal endoscopy due to its safety, rapid onset, shorter duration of action, anxiolysis, and amnesia (3). In addition, opiates provide analgesia, produces synergistic sedation with midazolam, and increase amnesia and patient satisfaction (4).…”

“…The use of conscious sedation is widespread presently, and results in a high degree of satisfaction with the procedure by both patients and physician (3, 4). However, there is no well-defined set of practice guidelines that can be used to determine which patients can undergo successful conscious sedation in gastrointestinal endoscopy.…”

Repeated Intranasal Flumazenil Administration in Adult Subjects During Prolonged Benzodiazepine-induced Sedation

“…The intranasal route for administration of medications in adult patients is also used for both naloxone [16] and for midazolam [17] when intravenous access has not yet been established or may be difficult, and when PO administration may not be practical. As reported in this study, a similar approach may be used for flumazenil to reverse sedation induced by benzodiazepines, for example in the emergency department.…”

Low-dose intranasal versus oral midazolam for routine body MRI of claustrophobic patients

“…In adults, the intranasal application of midazolam has been reported for sedation during upper gastrointestinal endoscopy, for premedication, as well as for the treatment of panic disorders [3,7,8]. However, the experience with midazolam in patients for radiological examinations and, in particular, in patients referred for MRI is limited.…”