Conscious sedation during endoscopic retrograde cholangiopancreatography: midazolam or midazolam plus meperidine?
OBJECTIVE
No consensus exists for the safest and most effective agent and for optimal drug doses for sedation during endoscopic retrograde cholangiopancreatography (ERCP). We aimed to compare the efficacy of midazolam with that of midazolam+meperidine, which provided comfort for the patient during ERCP.


METHODS
The patients were randomized to sedation with midazolam only (2.87+/-0.67 mg) (n=48, median age 55.54+/-14.66, 21 women, 27 men) or midazolam (1.82+/-0.71 mg) with meperidine (42.81+/-14.61 mg) (n= 48, median age 55.48+/-2.57, 20 women, 28 men). Procedure-related parameters and the efficacy of sedation as assessed by the endoscopist and the patients were compared.


RESULTS
Prior endoscopic history, preprocedure anxiety scores, age, sex, baseline vital signs and type of interventions were similar in both groups. Sedation level, duration of procedure and recovery time were comparable in both groups. Sedation quality assessment scale was significantly higher in the midazolam with meperidine group. Degree of pain sensed during the procedure was significantly lower in the midazolam with meperidine group. Midazolam with meperidine group had better patient satisfaction. Twenty-four hours after the procedure, the degree of amnesia between both sedation groups was similar. The number of patients unwilling to repeat the procedure was distinctly higher in midazolam group. Development of hypoxia and arrythmia in the midazolam and midazolam with meperidine groups were comparable. Two patients in the midazolam group developed paradoxical agitation.


CONCLUSIONS
Conscious sedation for ERCP can be successfully and safely achieved by using either only midazolam or a low dose of midazolam with meperidine. Adding of meperidine to midazolam resulted in better patient and endoscopist comfort.
Department of Gastroenterology, Numune Hospital, Ankara, Turkey.
Osman
O
Yüksel
Erkan
E
Parlak
Seyfettin
S
Köklü
Ibrahim
I
Ertugrul
Bilge
B
Tunç
Burhan
B
Sahin
D000759:Adjuvants, Anesthesia / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D001007:Anxiety; D016009:Chi-Square Distribution; D002760:Cholangiopancreatography, Endoscopic Retrograde; D016292:Procedural Sedation / Q000379:methods* / Q000523:psychology; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008614:Meperidine / Q000627:therapeutic use*; D008874:Midazolam / Q000627:therapeutic use*; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction
D000759:Adjuvants, Anesthesia; D006993:Hypnotics and Sedatives; D008614:Meperidine; D008874:Midazolam