CONSCIOUS SEDATION FOR GASTROSCOPY - PATIENT TOLERANCE AND CARDIORESPIRATORY PARAMETERS

Background/Aims: Most patients receive conscious sedation for gastrosc opy. However, the benefit of the most often used combination of low-do se intravenous midazolam and topical lidocaine on patient tolerance re mains poorly defined and has not been shown to outweigh cardiorespirat ory risks. To respond to these issues, a randomized, double-blind, pla cebo-controlled prospective study was performed. Methods: Two hundred outpatients undergoing diagnostic gastroscopy were assigned to receive either (1) midazolam (35 mu g/kg) and lidocaine spray (100 mg), (2) m idazolam and placebo lidocaine, (3) placebo midazolam and lidocaine, o r (4) placebo midazolam and placebo lidocaine. Results: Tolerance (vis ual analogue scale, 0-100 points; 0, excellent; 100, unbearable) impro ved as compared with placebo midazolam and placebo lidocaine by 23 poi nts (95% confidence interval, 15-32) in group 1, 15 points (95% confid ence interval, 7-24) in group 2, and 10 points (95% confidence interva l, 2-18) in group 3. Increasing age (P < 0.001), low anxiety (P < 0.00 1), and male sex (P < 0.03), but not amnesia, were associated with bet ter patient tolerance. Oxygen desaturation (<1 minute) occurred in 8.2 % and was not more frequent after midazolam treatment. Hypotension was rare (2.1%), and no adverse outcome occurred. Conclusions: Both low-d ose midazolam (35 mu g/kg) and lidocaine spray have an additive benefi cial effect on patient tolerance and rarely induce significant alterat ions in cardiorespiratory monitoring parameters, thus supporting the w idespread use of conscious sedation.