F. Froehlich et al., CONSCIOUS SEDATION FOR GASTROSCOPY - PATIENT TOLERANCE AND CARDIORESPIRATORY PARAMETERS, Gastroenterology, 108(3), 1995, pp. 697-704
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.