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Related Experiment Videos

Midazolam in upper gastrointestinal endoscopy: a single-blind dose-finding study.

L R Sutherland1, E Goldenberg, N Hershfield

  • 1Division of Gastroenterology, Foothills Hospital, University of Calgary, Alberta.

Clinical and Investigative Medicine. Medecine Clinique Et Experimentale
|April 1, 1989
PubMed
Summary

Midazolam effectively sedates patients for upper endoscopy. For optimal results without premedication, a dosage of 0.10 mg/kg is recommended, as higher doses offer no additional benefits.

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Area of Science:

  • Pharmacology
  • Gastroenterology

Background:

  • Midazolam is a water-soluble benzodiazepine known for its sedative and amnestic effects.
  • Upper endoscopy requires adequate sedation for patient comfort and procedural success.

Purpose of the Study:

  • To evaluate the efficacy of increasing midazolam dosages (0.05, 0.10, 0.15, 0.20 mg/kg) for sedation during upper endoscopy in unpremedicated patients.
  • To determine the optimal midazolam dosage for satisfactory sedation and minimal adverse effects.

Main Methods:

  • An open, non-randomized study involving 60 unpremedicated patients undergoing diagnostic upper endoscopy.
  • Efficacy was assessed using the Trieger test (psychomotor function), anterograde amnesia, patient rating (PR) of sedation, and physician's global assessment (PGA).

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Main Results:

  • Patient rating (PR) for sedation was consistently excellent-good across all tested midazolam doses.
  • Anterograde amnesia was observed in nearly all patients.
  • Psychomotor function (Trieger test) showed dose-dependent deterioration (p < 0.05).
  • Physician's global assessment (PGA) significantly improved with increasing dosage, from 26.7% at 0.05 mg/kg to 80.0% at 0.20 mg/kg (p < 0.01).
  • Treatment failure, requiring supplemental diazepam, occurred in 8/15 patients at 0.05 mg/kg, and 1 patient each at 0.10 and 0.15 mg/kg.
  • No significant changes in vital signs were noted. Phlebitis occurred in two patients receiving both midazolam and diazepam.

Conclusions:

  • Midazolam is well-tolerated and provides satisfactory sedation for upper endoscopy.
  • In the absence of premedication, dosages exceeding 0.10 mg/kg do not offer additional benefits for sedation efficacy.
  • The optimal dose for unpremedicated patients undergoing upper endoscopy appears to be 0.10 mg/kg.