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Randomized, double-blind trial of midazolam and diazepam for endoscopic sedation in children
V Tolia1, S L Fleming, R E Kauffman
1Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit.
Insights
Midazolam provided better amnesia and pain relief during pediatric esophagogastroduodenoscopy (EGD) compared to diazepam. More children preferred midazolam for future sedation, indicating improved procedural experience.
Area of Science:
- Pediatric Gastroenterology
- Anesthesiology
- Clinical Pharmacology
Background:
- Sedation is crucial for pediatric endoscopic procedures like esophagogastroduodenoscopy (EGD).
- Comparing the efficacy of commonly used sedatives, diazepam and midazolam, is important for optimizing patient care.
Purpose of the Study:
- To compare the efficacy of midazolam versus diazepam for sedation and amnesia in children undergoing EGD.
- To evaluate patient and physician assessments of sedation quality and patient recall post-procedure.
Main Methods:
- Prospective, randomized, double-blind study involving 41 children (6-18 years).
- Intravenous administration of midazolam (0.1-0.15 mg/kg) or diazepam (0.2-0.4 mg/kg).
- Assessment of sedation, amnesia, vital signs, and patient preferences post-EGD.
Main Results:
- No significant differences in physician assessments or recall of procedural events between groups.
- Midazolam group reported significantly less pain/discomfort at 1 and 24 hours (p=0.02).
- More patients in the midazolam group preferred it for future procedures.
Conclusions:
- Midazolam may offer superior amnesia and pain reduction in pediatric EGD compared to diazepam.
- Midazolam appears to improve the overall patient experience for endoscopic procedures in children.
Abstract:
We performed a prospective, randomized, double-blind study of 41 children (6-18 years of age) who were undergoing esophagogastroduodenoscopy (EGD) to compare the efficacy of diazepam and midazolam with respect to quality of sedation and amnesia. The endoscopist assessed the patients for control of salivation, gag reflex, vomiting and cooperation after intravenous injection of either 0.1-0.15 mg/kg of midazolam or 0.2-0.4 mg/kg of diazepam. The patients answered a questionnaire at 1 and 24 h after the procedure to assess recall of procedure details, pain and/or discomfort, and their medication choice for future procedures. Vital signs were monitored for 1 h after injection. Although midazolam caused greater mean maximum increase in heart rate than diazepam (30 vs. 14/min), no difference was found between the two treatment groups with respect to other vital signs. There was also no difference in physician's assessment or patient recall of specific events during the procedure. However, significantly fewer patients recalled pain or discomfort with midazolam at both 1 and 24 h following the procedure (p = 0.02). In addition, more patients receiving midazolam indicated preference for the same sedation for future procedures. We conclude that midazolam may provide better amnesia in children undergoing endoscopic procedures.