Premedication with orally administered lorazepam in adults undergoing ERCP: a randomized double-blind study

Area of Science:

• Gastroenterology
• Anesthesiology
• Clinical Pharmacology

Background:

• Restlessness during Endoscopic Retrograde Cholangiopancreatography (ERCP) frequently complicates the procedure and can lead to its premature termination.
• Effective sedation management is crucial for successful ERCP outcomes and patient comfort.

Purpose of the Study:

• To determine if oral lorazepam premedication can reduce the need for intravenous sedatives during ERCP.
• To assess the impact of lorazepam premedication on the quality of sedation achieved.

Main Methods:

• A randomized, double-blind, placebo-controlled trial was conducted.
• 95 inpatients undergoing therapeutic ERCP received either 1 mg oral lorazepam or a placebo prior to intravenous sedation with midazolam, propofol, and S(+)-ketamine.
• The primary outcome measured was the total amount of propofol administered to achieve adequate sedation.

Main Results:

• No significant differences were observed in heart rate, blood pressure, oxygen desaturations, or restlessness between the lorazepam and placebo groups.
• Patients pretreated with lorazepam required significantly higher doses of propofol during the early phase of sedation and a higher total amount of ketamine.
• Despite increased sedative requirements, both groups reported high satisfaction with the ERCP procedure.

Conclusions:

• Oral lorazepam premedication did not demonstrate an advantage in reducing sedative requirements or improving sedation quality during ERCP.
• Lorazepam premedication may be counterproductive when used in conjunction with other benzodiazepines, potentially increasing the overall sedative dose needed.
• Further research is needed to understand the complex interactions of premedication and sedation in ERCP.