title: Impairment state of cognitive performance and the affecting factors in outpatients following gastrointestinal endoscopy after single-dose diazepam.
abstract: Diazepam is commonly used as premedicant for endoscopic procedures. Wide interindividual differences have been observed in the residual cognitive effects of the drug after gastrointestinal endoscopy. Our aim was to clarify the major factors, including pharmacokinetic factors, contributing to this wide variation in residual cognitive effect after gastrointestinal endoscopy in the study. Sixty-one outpatients undergoing gastrointestinal endoscopy participated in the study. Cognitive effects were evaluated in the diazepam group (n=52) by the digit symbol substitution test (DSST) twice before and 30 min after an intravenous administration of 5 mg diazepam; in the intervening time gastrointestinal endoscopy was performed. Plasma concentrations of diazepam were determined by HPLC. The control group (n=9) was tested by DSST in the same manner. The cognitive effects according to the change in DSST score was significantly decline in the diazepam group compared with the control group (by 0.2 versus -4.6; P=0.014). This prospective study confirmed that cognition was significantly impaired after gastrointestinal endoscopy by premedication to subjects with 5 mg diazepam. There were very wide variations in change in DSST score. However we could not identify the independent variables that best predicted DSST score difference in a multiple regression analysis for age, plasma albumin level, and plasma diazepam concentration 30 min after intravenous administration. We should pay attention to patients' individual states in cognitive performance following gastrointestinal endoscopy after single-dose diazepam.
authors.affiliation: Course of Clinical Pharmacy, Graduate School of Pharmaceutical Sciences, Meiji Pharmaceutical University, Tokyo 204-8588, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Nakazono
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Shinichi
authors.initials: S
authors.lastname: Nakaya
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Asami
authors.forename: Keisou
authors.initials: K
authors.lastname: Masuhara
authors.forename: Fumio
authors.initials: F
authors.lastname: Itoh
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ogata
mesh_terms: D000328:Adult; D000368:Aged; D000483:Alleles; D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics; D003072:Cognition Disorders / Q000139:chemically induced* / Q000175:diagnosis; D065731:Cytochrome P-450 CYP2C19; D003975:Diazepam / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005838:Genotype; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D006899:Mixed Function Oxygenases / Q000235:genetics; D010045:Outpatients; D011229:Preanesthetic Medication; D011446:Prospective Studies
chemical_list: D014151:Anti-Anxiety Agents; D006899:Mixed Function Oxygenases; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D003975:Diazepam