title: Deep sedation occurs frequently during elective endoscopy with meperidine and midazolam.
abstract: OBJECTIVE
  Although moderate (conscious) sedation is intended during elective gastrointestinal endoscopy, unintended levels of deep sedation occur. The aims of this study were to prospectively evaluate the incidence and risk factors of deep sedation during elective endoscopy with meperidine and midazolam intended to maintain a level of moderate sedation.
  
  
  METHODS
  Eighty American Society of Anesthesiology class 1-2, outpatients presenting for elective esophagogastroduodenoscopy (EGD), colonoscopy, endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasonography (EUS) were offered enrollment. Intravenous meperidine and midazolam were administered according to a standardized protocol. Hemodynamic parameters and levels of sedation were assessed and recorded by a single observer at 3-min intervals. The Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale (ranging 1-5) is a subjective sedation assessment scale used to assess sedation levels. Occurrence of deep sedation, defined by MOAA/S 1-2, was recorded. Univariable and multivariable analyses were used to assess predictors of deep sedation.
  
  
  RESULTS
  Deep sedation occurred in 54/80 (68%) patients for a total of 204/785 (26%) of total sedation assessments. The percentage of deep sedation episodes of all sedation-level observations by procedure was 26% for EGD, 11% for colonoscopy, 35% for ERCP, and 29% for EUS. Deep sedation occurred at least once in 60% of EGD, 45% of colonoscopy, 85% of ERCP, and 80% of EUS. Multivariable analysis showed that only ERCP and EUS were independent risk factors of deep sedation.
  
  
  CONCLUSIONS
  Deep sedation occurs frequently during elective endoscopy with meperidine and midazolam used with the intent of moderate sedation. ERCP and EUS are risk factors for the occurrence of deep sedation, independent of sedation dose or length of procedure.
authors.affiliation: Section of Endoscopy, Department of Gastroenterology and Hepatology, The Cleveland Clinic Foundation, Cleveland, Ohio 44118, USA.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Patel
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
authors.forename: Farah
authors.initials: F
authors.lastname: Khandwala
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Pat
authors.initials: P
authors.lastname: Trolli
authors.forename: John A
authors.initials: JA
authors.lastname: Dumot
authors.forename: Darwin L
authors.initials: DL
authors.lastname: Conwell
authors.forename: Gregory
authors.initials: G
authors.lastname: Zuccaro
mesh_terms: D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D015331:Cohort Studies; D003113:Colonoscopy / Q000379:methods; D016292:Procedural Sedation / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D017558:Elective Surgical Procedures; D016145:Endoscopy, Digestive System / Q000379:methods*; D019160:Endosonography / Q000379:methods; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008297:Male; D008614:Meperidine / Q000008:administration & dosage*; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D018570:Risk Assessment
chemical_list: D006993:Hypnotics and Sedatives; D008614:Meperidine; D008874:Midazolam