Midazolam, a new more potent benzodiazepine, compared with diazepam: a randomized, double-blind study of...

Midazolam is a new imidazobenzodiazepine. It is more potent and has a shorter duration of action than diazepam. Forty patients undergoing upper gastrointestinal endoscopy for the first time were randomized to receive either diazepam or midazolam as the preendoscopic sedative agent. Both the patient and the endoscopist were blinded regarding the treatment group. Vital signs were monitored before, during, and after induction. Questionnaires were used to assess patient recall of the procedure, as well as endoscopist and patient satisfaction. Recovery from sedation was assessed using the Treiger test (i.e., connecting a series of sequential points with a line). Twenty-four hours and 1 to 2 weeks later, follow-up was obtained on all patients to evaluate for any delayed adverse effects. When compared to diazepam, midazolam was more potent and decreased induction time by more than 2.5 min (p less than 0.001). Recovery time and endoscopist and patient satisfaction were similar (p greater than 0.1), but patient recall was significantly less in the midazolam group (p less than 0.01). Fewer adverse reactions (e.g., thrombophlebitis) were noted with midazolam; however, the magnitude of the difference was not statistically significant. Hemodynamic parameters were also similar. It is concluded that midazolam is a safe, effective, and promptly acting sedative for upper gastrointestinal endoscopy. Compared to diazepam it was significantly more potent, faster acting, and associated with greater amnesia.