title: Administration of additional analgesics can decrease the incidence of paradoxical reactions in patients under benzodiazepine-induced sedation during endoscopic transpapillary procedures: prospective randomized controlled trial.
abstract: OBJECTIVE
  The aim of the present study was to evaluate the efficacy and safety of giving pentazocine as an analgesic with benzodiazepine during endoscopic retrograde cholangiopancreatography (ERCP).
  
  
  METHODS
  The paradoxical reactions (PR) incidence was evaluated as an indicator of usefulness. Transcutaneous arterial carbon dioxide tension (PtcCO(2) ) was evaluated as an indicator of safety. A total of 160 patients were enrolled. Subjects were randomly divided into two groups; group 1 sedated with midazolam only and group 2 sedated both with midazolam and pentazocine (7.5 mg).
  
  
  RESULTS
  The initial dosage introduced sedation before procedure was significantly higher in group 1. The occurrence rate of PR's in group 1 was significantly higher compared to that in group 2 (P = 0.0108). Although maximum PtcCO(2) observed during sedation did not differ between the two groups (48.7 ± 7.2, 50.3 ± 7.6 mmHg, respectively),maximum PtcCO(2) during the first 15 min after the start of sedation was significantly higher in group 2 than in group 1 (P = 0.0294). In multivariate analysis, procedure duration (odds ratio [OR] = 1.048) and midazolam dose (OR = 1.221) were predictive factors for PR.
  
  
  CONCLUSIONS
  The administration of pentazocine is significantly reduced the incidence of PR's in patients under midazolam induced sedation during ERCP.
authors.affiliation: Department of Gastroenterology and Hepatology, Iwate Medical University, Morioka, Japan.
authors.forename: Torahiko
authors.initials: T
authors.lastname: Terui
authors.forename: Masaaki
authors.initials: M
authors.lastname: Inomata
mesh_terms: D000759:Adjuvants, Anesthesia / Q000008:administration & dosage / Q000009:adverse effects*; D000368:Aged; D000704:Analysis of Variance; D002760:Cholangiopancreatography, Endoscopic Retrograde; D016292:Procedural Sedation / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006935:Hypercapnia; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D010423:Pentazocine / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000759:Adjuvants, Anesthesia; D006993:Hypnotics and Sedatives; D008874:Midazolam; D010423:Pentazocine