Propofol Alone versus Propofol in Combination with Midazolam for Sedative Endoscopy in Patients with Paradoxical Reactions to Midazolam
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background/Aims: The efficacy of propofol in gastrointestinal endoscopy for patients with midazolam-induced paradoxicalreactions remains unclarified. This study aimed to compare the efficacy and safety of propofol-based sedation in patients whopreviously experienced paradoxical reactions. Methods: This was a prospective, single-blinded, randomized controlled pilot study. Participants with a history of paradoxical reactions tomidazolam during a previous esophagogastroduodenoscopy were recruited and randomly assigned to group I (propofol monosedation)or group II (combination of propofol and midazolam). The primary endpoint was the occurrence of a paradoxical reaction. Results: A total of 30 participants (mean age, 54.7±12.6 years; male, 19/30) were randomly assigned to group I (n=16) or group II(n=14). There were no paradoxical reactions in group I, but there were two in group II, without a significant difference (p=0.209). The mean dose of propofol was higher in group I than in group II (p=0.002). Meanwhile, the procedure and recovery times did notdiffer between groups. Conclusions: Propofol-based sedation was safe and effective for patients who experienced paradoxical reactions to midazolam. However, caution is needed because few cases of paradoxical reaction again can happen in group II in which midazolam wasreadministered.
Abstract
Background/Aims: The efficacy of propofol in gastrointestinal endoscopy for patients with midazolam-induced paradoxicalreactions remains unclarified. This study aimed to compare the efficacy and safety of propofol-based sedation in patients whopreviously experienced paradoxical reactions. Methods: This was a prospective, single-blinded, randomized controlled pilot study. Participants with a history of paradoxical reactions tomidazolam during a previous esophagogastroduodenoscopy were recruited and randomly assigned to group I (propofol monosedation)or group II (combination of propofol and midazolam). The primary endpoint was the occurrence of a paradoxical reaction. Results: A total of 30 participants (mean age, 54.7±12.6 years; male, 19/30) were randomly assigned to group I (n=16) or group II(n=14). There were no paradoxical reactions in group I, but there were two in group II, without a significant difference (p=0.209). The mean dose of propofol was higher in group I than in group II (p=0.002). Meanwhile, the procedure and recovery times did notdiffer between groups. Conclusions: Propofol-based sedation was safe and effective for patients who experienced paradoxical reactions to midazolam. However, caution is needed because few cases of paradoxical reaction again can happen in group II in which midazolam wasreadministered.
참고문헌 (27)
- Yi SY, "Midazolam for patients undergoing upper gastrointestinal endoscopy : a prospective, single-blind and randomized study to determine the appropriate amount and time of initiation of endoscopy", J Gastroenterol Hepatol, 20, pp.1873~1879 (2005)
- Valori R, "Performance measures for endoscopy services : a European Society of Gastrointestinal Endoscopy(ESGE)quality improvement initiative", United European Gastroenterol J, 7, pp.21~44 (2019)
- Jun Kyu Lee, "Updates on the Sedation for Gastrointestinal Endoscopy", Clinical Endoscopy, 52(5), pp.451~457 (2019), 대한소화기내시경학회[DOI]
- Tae CH, "Paradoxical reaction to midazolam in patients undergoing endoscopy under sedation : incidence, risk factors and the effect of flumazenil", Dig Liver Dis, 46, pp.710~715 (2014)
- Gwan Woo Hong, "Comparison of Fentanyl versus Meperidine in Combination with Midazolam for Sedative Colonoscopy in Korea", Clinical Endoscopy, 53(5), pp.562~567 (2020), 대한소화기내시경학회[DOI]
- Mancuso CE, "Paradoxical reactions to benzodiazepines : literature review and treatment options", Pharmacotherapy, 24, pp.1177~1185 (2004)
- Weinbroum AA, "The midazolam-induced paradox phenomenon is reversible by flumazenil. Epidemiology, patient characteristics and review of the literature", Eur J Anaesthesiol, 18, pp.789~797 (2001)
- Honan VJ, "Paradoxical reaction to midazolam and control with flumazenil", Gastrointest Endosc, 40, pp.86~88 (1994)
- Rex DK, "Endoscopist-directed administration of propofol : a worldwide safety experience", Gastroenterology, 137, pp.1229~1237 (2009)
- 이준규, "진정내시경시 비마취과의사에 의한 프로포폴 투여의 안전성", 대한소화기학회지, 69(1), pp.55~58 (2017), 대한소화기학회[DOI]
- Levitzky BE, "Moderate sedation for elective upper endoscopy with balanced propofol versus fentanyl and midazolam alone : a randomized clinical trial", Endoscopy, 44, pp.13~20 (2012)
- Poulos JE, "Propofol compared with combination propofol or midazolam", fentanyl for endoscopy in a community setting, 2013, pp.81, 31~36
- Khoshoo V, "Propofol versus midazolam plus meperidine for sedation during ambulatory esophagogastroduodenoscopy", J Pediatr Gastroenterol Nutr, 37, pp.146~149 (2003)
- Lee TH, "Balanced propofol sedation versus propofol monosedation in therapeutic pancreaticobiliary endoscopic procedures", Dig Dis Sci, 57, pp.2113~2121 (2012)
- Dumonceau JM, "European society of gastrointestinal endoscopy, european society of gastroenterology and endoscopy nurses and associates, and the european society of anaesthesiology guideline : non-anesthesiologist administration of propofol for GI endoscopy", Endoscopy, 42, pp.960~974 (2010)
- Harris ZP, "Quality assurance in the endoscopy suite : sedation and monitoring", Gastrointest Endosc Clin N Am, 26, pp.553~562 (2016)
- McGrath B, "Postoperative recovery and discharge", Anesthesiol Clin North Am, 21, pp.367~386 (2003)
- Golparvar M, "Paradoxical reaction following intravenous midazolam premedication in pediatric patients-a randomized placebo controlled trial of ketamine for rapid tranquilization", Paediatr Anaesth, 14, pp.924~930 (2004)
- Massanari M, "Paradoxical reactions in children associated with midazolam use during endoscopy", Clin Pediatr(Phila), 36, pp.681~684 (1997)
- Terui T, "Administration of additional analgesics can decrease the incidence of paradoxical reactions in patients under benzodiazepine-induced sedation during endoscopic transpapillary procedures : prospective randomized controlled trial", Dig Endosc, 25, pp.53~59 (2013)
- Shin S, "Conventional versus analgesia-oriented combination sedation on recovery profiles and satisfaction after ERCP : a randomized trial", PLoS One, 10, pp.e0138422~ (2015)
- VanNatta ME, "Propofol alone titrated to deep sedation versus propofol in combination with opioids and", or benzodiazepines and titrated to moderate sedation for colonoscopy, 2006, pp.101, 2209~2217
- Kiriyama S, "Propofol sedation during endoscopic treatment for early gastric cancer compared to midazolam", World J Gastroenterol, 20, pp.11985~11990 (2014)
- Yoshihide Kanno, "Safety and Recipient Satisfaction of Propofol Sedation in Outpatient Endoscopy: A 24-Hour Prospective Investigation Using a Questionnaire Survey", Clinical Endoscopy, 54(3), pp.340~347 (2021), 대한소화기내시경학회[DOI]
- Cohen LB, "Endoscopic sedation in the United States : results from a nationwide survey", Am J Gastroenterol, 101, pp.967~974 (2006)
- Park CH, "Outcomes of propofol sedation during emergency endoscopy performed for upper gastrointestinal bleeding", Dig Dis Sci, 61, pp.825~834 (2016)
- Lee SH, "Factors related to paradoxical reactions during propofol-induced sedated endoscopy", Scand J Gastroenterol, 54, pp.371~376 (2019)
