Premedication with orally administered lorazepam in adults undergoing ERCP: a randomized double-blind study.
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.
Weitz
Gunther
G
Division of Gastroenterology, Department of Internal Medicine I, University of Schleswig-Holstein Campus Lübeck, Lübeck, Germany.
Homann
Nils
N
von Jagow
Dorothea Clara
DC
Wellhöner
Peter
P
Sauer
Arik
A
Ludwig
Diether
D
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
D006993:Hypnotics and Sedatives; D008140:Lorazepam; D008874:Midazolam; D015742:Propofol