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Intravenous ketorolac tromethamine versus meperidine for adjunctive sedation in upper gastrointestinal endoscopy: a
D F Dies1, W K Clarkston, C L Schratz
1Division of Gastroenterology/Hepatology, St. Louis University Health Sciences Center, Missouri, USA.
Background:
Meperidine is commonly used with a benzodiazepine to achieve conscious sedation but may potentiate respiratory depression. Ketorolac tromethamine has few sedative effects and no respiratory depression. The purpose of this study was to compare ketorolac to meperidine as adjuncts in conscious sedation for upper gastrointestinal endoscopy (EDG).
Methods:
Patients undergoing diagnostic EGD (n = 47) were randomly assigned to receive normal saline solution or 50 mg meperidine or 30 mg ketorolac intravenously. Midazolam was subsequently administered (as needed, to achieve adequate conscious sedation) by endoscopists who were blinded to the test substance given before the procedure.
Results:
For all treatment groups, there was no significant difference in extent or adequacy of sedation, incidence of oxygen desaturation, patient amnesia, time of procedure, or vital signs (except for a relative procedural tachycardia in the ketorolac and placebo groups as compared to baseline). The ketorolac group experienced more pain and anxiety. The meperidine group experienced less gagging, a shorter sedation time, less midazolam usage, and more discomfort at the intravenous site. Meperidine seemed to offer a "protective" effect against procedural tachycardia.
Conclusion:
There is no benefit to ketorolac as an adjunct in conscious sedation for EGD. Meperidine had several benefits; however, discomfort at the intravenous site was common.