The comparison of midazolam and topical lidocaine spray versus the combination of midazolam, meperidine, and topical lidocaine spray to sedate patients for upper endoscopy

Background: Whether an opiate-benzodiazepine combination is superior to ben zodiazepine alone for sedation in upper endoscopy is controversial. The pur pose of this study was to compare the effectiveness of intravenous midazola m alone versus the combination of intravenous midazolam and intravenous mep eridine for the sedation of patients undergoing upper endoscopy, Methods: One hundred seven patients scheduled for outpatient diagnostic eso phagogastroduodenoscopy were randomly assigned to receive 50 mg intravenous meperidirae (53 of 107) or placebo (54 of 107), All patients received topi cal lidocaine spray and as much midazolam as the endoscopist thought the pa tient needed. Patients and endoscopists were blinded as to assignment. Data collected included intubation time (seconds), procedure time (minutes), pu lse, blood pressure, complications, and the need for reversal agents. The e ndoscopist evaluated the quality of sedation immediately after the procedur e (1 = excellent, 2 = good, 3 = fair, and 4 = poor). The patient evaluated the procedure the next day by phone (1 = no discomfort or did not remember, 2 = slightly uncomfortable, 3 = extremely uncomfortable, and 4 = unaccepta ble). Patients were also asked whether they would agree to another esophago gastroduodenoscopy if their doctor thought it was medically necessary. Results: The intubation time, procedure time and blood pressure were not si gnificantly different between the 2 groups. In comparing the meperidine gro up versus placebo group, the highest pulse (82.3 vs. 93.7, p = 0.0010), low est pulse (67.2 vs, 72.3, p = 0.0194) and amount of midazolam used (4.0 vs. 4.8 mg, p = 0.0185 or 0.53 vs, 0.67 mg/kg, p = 0.0083) were significantly different by using a t test analysis. Patient evaluations comparing meperid ine versus placebo showed responses of 1 (52 vs, 49), 2 (1 vs. 3), 3 (0 vs, 2) and 4 (0 vs. 0), which were not significantly different. The endoscopis ts' evaluation comparing meperidine versus placebo gave responses of excell ent (44 vs. 27), good (6 vs. 22), fair (3 vs. 5) and poor (0 vs. 0), which were highly significantly different (p < 0.001) by using chi-square statist ical techniques. Conclusion: The addition of meperidine to midazolam in sedating patients un dergoing upper endoscopy adds no benefit from the patient viewpoint, wherea s endoscopists favored the use of both medications.