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Sedation with meperidine and midazolam in pediatric patients undergoing endoscopy
N Bahal-O'Mara1, M C Nahata, R D Murray
1College of Pharmacy, Ohio State University, Columbus 43210.
Insights
Adding midazolam to meperidine significantly increased amnesia in pediatric outpatients undergoing endoscopy. Both regimens showed similar overall efficacy and safety profiles for this procedure.
Area of Science:
- Pediatric Gastroenterology
- Clinical Pharmacology
- Anesthesiology
Background:
- Sedation is crucial for pediatric endoscopy.
- Meperidine and midazolam are commonly used agents.
- Optimizing sedation regimens improves patient experience and procedural success.
Purpose of the Study:
- To compare the efficacy and safety of meperidine alone versus meperidine plus midazolam in pediatric outpatients undergoing upper endoscopy.
- To evaluate the impact of combined sedation on patient cooperation, distress, and amnesia.
Main Methods:
- Randomized, double-blind trial involving 40 pediatric outpatients (ages 1-17 years).
- Comparison of meperidine (M) 2 mg/kg versus meperidine (M) 2 mg/kg plus midazolam (M) 0.05 mg/kg.
- Assessment of procedural efficacy, cooperation, emotional status, drowsiness, negative behaviors, vital signs, and oxygen saturation.
Main Results:
- No significant differences in overall efficacy or safety between the two regimens.
- Significantly higher rates of amnesia in the meperidine plus midazolam group (78%) compared to the meperidine group (23%) (P = 0.002).
- Amnesia occurred more frequently in older children (>11 years) receiving the combination therapy.
Conclusions:
- Meperidine plus midazolam provides superior amnesia compared to meperidine alone for pediatric upper endoscopy.
- The combination regimen is safe and effective, with no significant differences in adverse events or vital signs.
- This combination may enhance patient comfort and procedural tolerance in pediatric endoscopy.
Abstract:
We conducted a randomized, double-blind trial evaluating the efficacy and safety of meperidine 2 mg.kg-1 (M) and meperidine 2 mg.kg-1 plus midazolam 0.05 mg.kg-1 (M + M) in 40 pediatric outpatients (age 1 to 17 years) undergoing upper endoscopy procedures. The physician and nurse performing the procedure were asked to rate cooperation, emotional status, drowsiness, and overall efficacy. A blinded observer recorded the frequency of negative behaviors indicating distress, vital signs, and oxygen saturation before, during, and after the procedure. No significant differences were noted in the overall efficacy of the regimens. Good or excellent efficacy was noted in 15 of 21 children (71%) in the M group and 15 of 19 children (79%) in the M + M group by physicians; nurses assigned a good or excellent rating for 14 of 21 (67%) and 13 of 19 (68%) in the M and M + M groups, respectively. Immediately following the procedure, amnesia was noted in 4 of 17 (23%) patients who received M versus 14 of 18 (78%) patients who received M + M (P = 0.002). Of the children who received M + M, the amnesia tended to occur more frequently in older children (> 11 years, 8 children, rate of amnesia 100%) than in younger children (< or = 11 years, 6 of 10 evaluable children, rate of amnesia 60%). There was no significant difference between the frequency of negative behaviors, rate of adverse effects, or changes in vital signs or oxygen saturation noted with the two drug regimens.(ABSTRACT TRUNCATED AT 250 WORDS)