title: Premedication with orally administered lorazepam in adults undergoing ERCP: a randomized double-blind study.
abstract: BACKGROUND
  Restlessness often complicates ERCP and may be a reason for premature termination of the procedure.
  
  
  OBJECTIVE
  Our purpose was to evaluate whether a premedication with orally administered lorazepam could reduce the need for sedatives and improve sedation quality.
  
  
  METHODS
  Randomized double-blind trial.
  
  
  METHODS
  Therapeutic ERCP with an intravenous sedation containing midazolam, propofol, and S(+)-ketamine.
  
  
  METHODS
  95 inpatients (aged 20-91 years).
  
  
  METHODS
  1 mg of lorazepam (n=47) or placebo (n=48) given orally before ERCP.
  
  
  METHODS
  Total amount of administered propofol.
  
  
  RESULTS
  Heart rate, blood pressure, number of oxygen desaturations, and states of restlessness did not differ between the groups. The same amount of midazolam was administered in both groups. There was no significant difference in the total amount of propofol to achieve adequate sedation (lorazepam vs placebo: 71+/-5 vs 63+/-4 microg/kg/min, mean+/-SE). Paradoxically, patients pretreated with lorazepam even needed more propofol in the early phase of sedation (275+/-39 vs 159+/-37 microg/kg in minutes 5-10, P<.05) and the total amount of ketamine administered was higher in this group as well (15.8+/-1.4 vs 11.3+/-1.2 microg/kg/min, P<.05). In both groups there were high rates of satisfaction with the course of the procedure evaluated both by the endoscopists and the patients.
  
  
  CONCLUSIONS
  The trial failed to show an advantage of an oral premedication with lorazepam. The amount of sedatives administered in the lorazepam group even tended to be higher. A premedication with lorazepam may be counterproductive when followed by sedation containing another benzodiazepine.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine I, University of Schleswig-Holstein Campus Lübeck, Lübeck, Germany.
authors.forename: Gunther
authors.initials: G
authors.lastname: Weitz
authors.forename: Nils
authors.initials: N
authors.lastname: Homann
authors.forename: Dorothea Clara
authors.initials: DC
authors.lastname: von Jagow
authors.forename: Peter
authors.initials: P
authors.lastname: Wellhöner
authors.forename: Arik
authors.initials: A
authors.lastname: Sauer
authors.forename: Diether
authors.initials: D
authors.lastname: Ludwig
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D016292:Procedural Sedation; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008140:Lorazepam / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D011229:Preanesthetic Medication; D015742:Propofol; D011595:Psychomotor Agitation / Q000517:prevention & control
chemical_list: D006993:Hypnotics and Sedatives; D008140:Lorazepam; D008874:Midazolam; D015742:Propofol