Midazolam sedation for upper gastrointestinal endoscopy in older persons: a randomized, double-blind, placebo-controlled study.
OBJECTIVE
To investigate the benefits and risks of using midazolam for sedation during upper gastrointestinal endoscopic procedures in older persons.


METHODS
Randomized, double-blind, placebo-controlled study.


METHODS
A 304-bed geriatric university hospital.


METHODS
Sixty-five geriatric inpatients (mean age 84 +/- 7) undergoing gastroscopy.


METHODS
Sedation with either midazolam (30 microg/kg IV) or saline (placebo). All patients received supplemental oxygen during the procedure (2 L/minute).


RESULTS
Patients' recall of their tolerance to the exam (categorical scale) and pain score were significantly in favor of midazolam at 2 and 24 hours. Multivariate analysis at 2 hours showed that midazolam increased the probability of good tolerance (odds ratio (OR) = 19.3; 95% confidence interval (CI) 2.2-170.4, P = .008). Circumstantial amnesia occurred at 24 hours in 84% (midazolam) versus 27% (placebo) (P < .001). With midazolam, mean sedation time was 83 +/- 13 minutes and mean arterial pressure (MAP) was about 10 mm Hg lower without clinically significant hypotension. Hypoxemia (SaO2 < 92%) was more frequent in the midazolam group after endoscopy (44% vs. 18%, P = .033), but no major desaturation was observed. Cognitive function (Mini-Mental State Exam, MMSE) was similar before and 2 and 24 hours after the exam in both groups. Acute confusion was observed in two patients (1 midazolam, 1 placebo). In multivariate analysis, midazolam was associated with a higher risk of hypoxemia after endoscopy (OR = 3.5; 95% CI 1.1-10.8, P = .029) but not of confusion.


CONCLUSIONS
Under adequate surveillance, the benefits in terms of tolerance to the procedure of low-dose midazolam for upper gastrointestinal endoscopic sedation outweigh the risks in older people.
Christe
C
C
Department of Geriatrics, University Hospitals of Geneva, Switzerland.
Janssens
J P
JP
Armenian
B
B
Herrmann
F
F
Vogt
N
N
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D014151:Anti-Anxiety Agents; D016292:Procedural Sedation; D004311:Double-Blind Method; D005260:Female; D005773:Gastroscopy; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008874:Midazolam; D010146:Pain / Q000517:prevention & control*; D017060:Patient Satisfaction
D014151:Anti-Anxiety Agents; D008874:Midazolam