The effect of sedation during upper gastrointestinal endoscopy

Abstract

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.

Efficacy and safety of etomidate–midazolam for screening colonoscopy in the elderly

“…Recently, endoscopic sedation has been widely used. [ 4 , 18 , 25 ] Although propofol is commonly used as sedative for endoscopic procedures, respiratory depression is a major problem. [ 5 , 8 , 26 ] Etomidate has emerged as a new sedative that does not affect cardiopulmonary function.…”

S3 Guideline: Sedation for gastrointestinal endoscopy 2008

“…There are no reports in the literature on tachycardia requiring intervention, only on frequent supraventricular and ventricular extrasystoles [219]. In emergencies, class Ia -IV antiarrhythmics should be given intravenously and a defibrillator should be kept at hand according to the guidelines of the cardiological professional associations [220].…”

Seguridad y eficiencia de sedación balanceada con propofol y remifentanil en endoscopia digestiva alta diagnóstica. Una experiencia exitosa

“…La serie muestra que para el endoscopista el procedimiento global fue fácil en el 94% (asociado con niveles de sedación II y III), adecuado en el 3% (para niveles de sedación I y IV, en los que se requirió dosis adicional de medicamentos o estímulo vigoroso, que ambos interrumpían momentáneamente la continuidad de la endoscopia, sin necesidad de retirar el endoscopio); y difícil en el 3% (asociado con niveles de sedación V que exigieron interrupción del examen, asistencia ventilatoria con dispositivo de presión positiva -en un solo caso con intubación orotraqueal-y una vez recuperada la ventilación espontánea con reintroducción del endoscopio) (12).…”