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Propofol versus midazolam plus meperidine for sedation during ambulatory esophagogastroduodenoscopy
Vikram Khoshoo1, Dipu Thoppil, Lisa Landry
1West Jefferson Medical Center, New Orleans, Louisiana, USA. vkhoshoo@earthlink.net
Insights
Propofol offers a safe and effective sedation option for pediatric esophagogastroduodenoscopy (EGD), leading to faster induction and recovery times compared to meperidine and midazolam.
Area of Science:
- Pediatric Gastroenterology
- Anesthesiology
- Pharmacology
Background:
- Esophagogastroduodenoscopy (EGD) is a common diagnostic procedure in children.
- Sedation is crucial for patient comfort and procedural success during pediatric EGD.
- Evaluating optimal sedation agents is essential for improving procedural efficiency and safety.
Purpose of the Study:
- To compare the efficacy and safety of propofol versus meperidine plus midazolam for sedation during pediatric EGD.
- To assess key outcomes including sedation onset, procedure length, recovery time, and need for interventions.
Main Methods:
- A retrospective and prospective study involving 260 neurologically intact children undergoing ambulatory EGD.
- Patients received either propofol with or without midazolam (PM group, n=155) or midazolam plus meperidine (MM group, n=105).
- Outcome variables included sedation induction time, procedure duration, recovery time, and need for restraint or additional support.
Main Results:
- The propofol group (PM) demonstrated significantly faster sedation onset, shorter procedure lengths, and quicker recovery times compared to the meperidine-midazolam group (MM) (P < 0.01).
- The MM group required physical restraint more frequently.
- Higher doses of meperidine and midazolam in the prospective MM cohort led to deeper sedation but increased the need for additional supportive measures.
Conclusions:
- Propofol is a safe and effective agent for facilitating esophagogastroduodenoscopy in pediatric patients.
- Propofol-based sedation offers advantages in terms of speed and efficiency for pediatric EGD compared to traditional meperidine-midazolam combinations.
Objective:
To evaluate the efficacy and safety of propofol and meperidine plus midazolam for sedation during esophagogastroduodenoscopy (EGD) in children.
Methods:
Data were collected prospectively and retrospectively from neurologically intact children (0.2-17.7 years of age) who underwent ambulatory diagnostic EGD during a 4-year period. Data were included from 155 consecutive patients receiving propofol with or without premedication with midazolam (PM group). One hundred five consecutive patients who received sedation with a midazolam plus meperidine combination served as a comparison (MM group). Outcome variables were: time required for induction of sedation, length of procedure, time for recovery, need for additional supportive measures, and need for physical restraint.
Results:
The onset of sedation was faster and the length of procedure and recovery were significantly shorter in the PM group as compared with the MM group (P < 0.01). Patients in the MM group required restraint more often than in the PM group. A higher dose of meperidine and midazolam was used in the prospective study. This led to deeper sedation but increased need for additional support.
Conclusions:
Propofol is safe and effective for facilitating EGD in children.