SEDATION FOR UPPER GASTROINTESTINAL ENDOSCOPY - A COMPARISON OF ALFENTANIL-MIDAZOLAM AND MEPERIDINE-DIAZEPAM

The authors studied the efficacy and cost of substituting sedation usi ng midazolam and alfentanil for the existing regimen of diazepam and m eperidine in patients requiring upper gastrointestinal endoscopy. Sixt y consenting subjects were randomized to receive either meperidine 50 mg with diazepam approximately 90 mu g.kg-1 (Group D) or alfentanil 25 0 mu g with midazolam approximately 50 mu g.kg(-1) (Group M). Endoscop e insertion time, patient acceptance, apnoeic or desaturation episodes were noted by a physician observer. Pulse oximetry was used to monito r heart rate and oxygen saturation (SpO(2) during endoscopy. Subjects performed four-choice reaction time (4CRT) tests before, 30 and 60 min after endoscopy, and were assessed for nausea or dizziness and their ability to stand and walk. During endoscopy, insertion time was shorte r 184 +/- 45 sec vs 122 +/- 83 sec, P < 0.03) and fewer aversive movem ents occurred (0.4 +/- 0.6 vs 1.7 +/- 2.4, P < 0.005) in Group M than Group D. No subject in either group suffered any apnoea or prolonged d esaturation requiring supplemental oxygen Irrespective of treatment gr oup, greater decreases in SpO(2) (6.1 +/- 3.4% vs 3.6 +/- 2.2%, P < 0. 001) occurred in subjects >45 yr of age than in subjects less than or equal to 45 yr. During recovery 4CRT values at 30 min after endoscopy were longer (723 +/- 226 msec vs 594 +/- 139 msec, P < 0.005) in Group M than in Group D but not after 60 min. It was concluded that the sma ll differences in endoscopy conditions and greater sedation during the first 30 min of recovery did not justify the additional cost of using midazolam and alfentanil.