70 EFFICACY, SAFETY, AND TOLERANCE OF ESOPHAGOGASTRODUODENOSCOPY WITH COMBINED MIDAZOLAM PLUS FENTANYL VERSUS MIDAZOLAM ALONE. (1st January 2006)

• Record Type: Journal Article
• Authors: Barriga, J.; Brown, G.; Royal, L.; Marino, C.; Tombazzi, C.
• Is Part Of: Journal of investigative medicine. Volume 54:Number 1(2006)
• Page Start: S268
• Page End: S268
• Publication Date: 2006-01-01
• Subjects: Clinical medicine -- Periodicals; Medicine -- Research -- Periodicals; Medicine; Research -- United States; Clinical medicine; Medicine -- Research; Periodicals; 616.075
• DOI: 10.2310/6650.2005.X0008.69
• Languages: English
• ISSNs: 1081-5589

Abstract

Abstract : Introduction: Esophagogastroduodenoscopy (EGD) is usually done under conscious sedation. In the USA most EGDs are performed with a combination of a short-acting benzodiazepine and a narcotic. The benefit of using one or two drugs has remained unproven. Objective: To evaluate adequacy, tolerance and possible differences in security of conscious sedation in upper endoscopy using midazolam alone vs midazolam plus fentanyl. Materials and Method: We included patients older than 18 years old who underwent elective, diagnostic outpatient EGD. Patients where randomized to receive either the combination of fentanyl/midazolam (F/M) or midazolam alone (M). The dose of medication was decided by the endoscopist. The adequacy of sedation obtained was assessed with a questionnaire answered by the physician at the end of the procedure and by the patient 24-72 hours after endoscopy. Patients were contacted by telephone and asked (1) about their tolerance classified as excellent/good vs fair/poor; (2) degree of recollection of the procedure: none or vague recollection vs remembers good part of it/everything; and (3) level of pain during the procedure: none or mild vs moderate or extreme discomfort. Results: We collected data from 71 patients. Thirty-four patients were assigned to the M group and 37 to the F/M group. Deviation of protocol or early termination because of poor tolerance occurred in 4 patients in the M group and 2 in the F/M group. Based on the endoscopist evaluation, there was no difference in the patient's tolerance: excellent/good in 63.3% of patients in the M group and 82.8% in the F/M group (p: .074). We were not able to contact one patient after EGD (M group). Per patient's assessment: excellent/good tolerance was found in 93% of the M group and 94% in the F/M group (p: 1.0); no or minimal recollection in 82.8% (F/M) vs 89.6% (M) (p: .49); no/mild discomfort in 91.4% in the F/M group vs 93.1% in the M group (p: 1). No difference in duration of the procedure was found between the 2 groups. No complications during endoscopies were reported. Mean dose of midazolam in the single-drug group was 3.5 mg and 2.5 mg in the combination group. Mean dose of fentanyl was 78.5 μg. Conclusion: In diagnostic upper endoscopy an adequate level of sedation can be obtained safely with either midazolam or midazolam + fentanyl.