Can sedation reduce the cardiac stress during gastrointestinal endoscopy? A study with non-invasive automated cardiac flow measurement by color Doppler echocardiography.
BACKGROUND
Upper gastrointestinal endoscopy (UGIE) may cause some cardiac stress. The effect of sedation on hemodynamics during UGIE has not been fully studied, and therefore the aim of this study was to clarify whether or not sedation can reduce cardiac stress dufing UGIE.


METHODS
Eight normal male volunteers undergoing UGIE with sedation (0.1 mg/kg of midazolam) and without it (two endoscopies per volunteer in random order) were monitored throughout the procedure by means of electrocardiogram, blood pressure and peripheral oxygen saturation (SpO2). Cardiac output was measured at six points before, during and after endoscopy from automated cardiac flow measurement by color Doppler echocardiography. Serum norepinephrine, epinephrine, dopamine and ACTH concentrations were measured before and after the examination.


RESULTS
No significant differences in heart rate, systolic blood pressure, rate-pressure product, cardiac output and left ventricular work index were observed between the sedated and non-sedated groups. SpO2 hardly changed during endoscopy in the non-sedated group, but decreased slightly in the sedated group (P = 0.075). Although all serum catecholamine concentration changes were within normal limits in both groups, after endoscopy only epinephrine concentration was significantly lower in the sedated group than in the non-sedated group (P = 0.0027).


CONCLUSIONS
Conscious sedation with midazolam does not reduce the cardiac stress during UGIE.
Yazawa
K
K
Second Dept of Surgery, Shinshu University School of Medicine, Asahi, Matsumoto, Japan.
Adachi
W
W
Owa
M
M
Koide
N
N
Hanazaki
K
K
Kajikawa
S
S
Kobayashi
S
S
Amano
J
J
D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D002395:Catecholamines / Q000097:blood; D018618:Echocardiography, Doppler, Color; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D008991:Monitoring, Physiologic; D013312:Stress, Physiological / Q000097:blood / Q000209:etiology* / Q000517:prevention & control*
D002395:Catecholamines; D006993:Hypnotics and Sedatives; D000324:Adrenocorticotropic Hormone; D008874:Midazolam