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

LaLuna, Louis; Allen, Melvin L.; DiMarino, Anthony J.

doi:10.1016/s0016-5107(01)70400-2

Cited by 38 publications

(15 citation statements)

References 20 publications

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“…[9] Our observations are similar; there was no difference in the patient’s level of discomfort with sedation. Even though the endoscopy was easy or satisfactory in the majority of patients in the unsedated and sedated groups, the endoscopists found it difficult to perform endoscopy in unsedated patients more often (9.75% vs .…”

Section: Discussionsupporting

confidence: 70%

The effect of sedation during upper gastrointestinal endoscopy

Sachdeva

Bhalla

Sood

et al. 2010

Saudi J Gastroenterol

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Background/Aim:We aimed to study whether sedation reduces discomfort during endoscopy and a comparison of longer-acting diazepam with shorter-acting midazolam.Patients and Methods:A prospective, randomized, single-blinded study was conducted at the Department of Medicine at Government Medical College and Hospital, Chandigarh, and was completed over a period of 6 months. The patients were randomized to receive either placebo or sedation with midazolam or diazepam before endoscopy. The endoscopist and the observer recording patient’s/physician’s responses were blinded to the drugs administered. Two hundred and fifty two consecutive patients undergoing diagnostic or therapeutic upper gastrointestinal endoscopy were recruited. The patient’s discomfort and the physician’s comfort during the procedure were recorded on a visual analogue scale rated from 1-10 with-in 10 minutes of the procedure by an independent observer. The Patient’s discomfort ratings were further divided into 3 groups, comfortable (score, 1-3), satisfactory (score, 4-7) and uncomfortable (a score of >7). Similarly the physician’s ease of performing the procedure was also recorded on the same scale. This was again divided into 3 groups: easy (score, 1-3), satisfactory (score, 4-7) and difficult (a score of >7).Results:Out of the total of 252 patients, 82 patients received no sedation (group I), 85 received diazepam (group II) and 85 received midazolam (group III). There was no statistical difference in the discomfort experienced by the patients during endoscopy when sedation was used (P=0.0754). Out of 252 patients, 49 underwent endoscopic procedures. Nineteen patients were included in group I, 18 in group II and 12 in group III. Only 10 (20%) patients undergoing endoscopic procedures complained of significant discomfort, but there was no difference in the ones undergoing interventions with or without sedation (P=0.854). The physicians were more comfortable in performing endoscopic procedure in sedated patients, however, the difference between patients in group II and group III was not statistically significant (P=0.0461). Both diazepam and midazolam fared equally well in increasing physician’s comfort (P=0.617).Conclusion:There was no difference in the patient’s discomfort with regard to the sedative used (midazolam or diazepam). Although endoscopy was easy or satisfactory in the majority of patients in the unsedated as well as the sedated groups, more often the endoscopist found it difficult to do endoscopy on the unsedated patients.

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Section: Discussionsupporting

confidence: 70%

The effect of sedation during upper gastrointestinal endoscopy

Sachdeva

Bhalla

Sood

et al. 2010

Saudi J Gastroenterol

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“…In the RCT comparing a placebo and a combination of midazolam/pethidine hydrochloride (evidence level, II), adequate sedation improved patient satisfaction and the rate of requesting re‐examination, and no adverse events were reported. A benzodiazepine alone and a benzodiazepine/analgesic combination were compared in two RCTs (evidence level, II) . Midazolam was used in both RCTs and pethidine hydrochloride and nalbuphine (an opioid, not available in Japan) were used for an analgesic.…”

Section: Statements On Sedation In Gastroenterological Endoscopymentioning

confidence: 99%

Guidelines for sedation in gastroenterological endoscopy

Obara

Haruma

Irisawa

et al. 2015

Digestive Endoscopy

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Recently, the need for sedation in gastrointestinal endoscopy has been increasing. However, the National Health Insurance Drug Price list in Japan does not include any drug specifically used for the sedation. Although benzodiazepines are the main medication, their use in cases of gastrointestinal endoscopy has not been approved. This has led the Japan Gastrointestinal Endoscopy Society to develop the first set of guidelines for sedation in gastrointestinal endoscopy on the basis of evidence‐based medicine in collaboration with the Japanese Society for Anesthesiologists. The present guidelines comprise 14 statements, five of which were judged to be valid on the highest evidence level and three on the second highest level. The guidelines are not intended to strongly recommend the use of sedation for gastrointestinal endoscopy, but rather to indicate the policy as to the choice of appropriate procedures when such sedation is deemed necessary. In clinical practice, the final decision as to the use of sedation should be made by physicians considering patient willingness and physical condition.

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“…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 . The study, however, involved small number (∼50/group) of patients, and the result is at risk of a type II error.…”

Section: Discussionmentioning

confidence: 95%

“…In this regard, minimal sedation with meperidine is quite similar to no sedation. The impact of meperidine as a single agent in EGD remains controversial . A brief report showed that the use of meperidine as a single sedative agent for EGD was not beneficial in reducing retching and agitation .…”

Section: Introductionmentioning

confidence: 99%