title: How to improve patient satisfaction during midazolam sedation for gastrointestinal endoscopy?
abstract: OBJECTIVE
  To determine the procedure-related factors that affect sedation satisfaction and to make a suggestion to improve it.
  
  
  METHODS
  We prospectively enrolled a total of 456 patients who underwent outpatient endoscopy procedures with midazolam sedation between March 2014 and August 2014. All patients completed both pre- and post-endoscopy questionnaires about sedation expectations and satisfaction.
  
  
  RESULTS
  The study cohort included 167 (36.6%) patients who underwent esophagogastroduodenoscopy (EGD), 167 (36.6%) who underwent colonoscopy, and 122 (26.8%) who underwent a combined procedure (EGD and colonoscopy). Over 80% of all patients were satisfied with sedation using midazolam. In univariate and multivariate analyses, total procedure time in the EGD group, younger age (≤ 50 years), and longer colonoscopy withdrawal time in the colonoscopy group were related to decreased satisfaction with sedation. However, in active monitoring and intervention group, there was no decrease in grade of satisfaction despite longer procedure time due to more procedures during colonoscopy. Younger age (≤ 50 years), longer inter-procedure time gap, and colonoscopy withdrawal time were related to decreased satisfaction in the combined EGD and colonoscopy group.
  
  
  CONCLUSIONS
  Midazolam is still a safe and effective sedative for gastrointestinal endoscopy. Satisfaction with sedation depends on several factors including age (≤ 50 years) and procedure time duration. To improve patient satisfaction with sedation, active monitoring of sedation status by the endoscopist should be considered for patients who require long procedure time.
authors.affiliation: Eun Hyo Jin, Ji Yeon Seo, Ji Min Choi, Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 135-984, South Korea.
authors.forename: Eun Hyo
authors.initials: EH
authors.lastname: Jin
authors.affiliation: Eun Hyo Jin, Ji Yeon Seo, Ji Min Choi, Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 135-984, South Korea.
authors.forename: Kyoung Sup
authors.initials: KS
authors.lastname: Hong
authors.affiliation: Eun Hyo Jin, Ji Yeon Seo, Ji Min Choi, Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 135-984, South Korea.
authors.forename: Young
authors.initials: Y
authors.lastname: Lee
authors.affiliation: Eun Hyo Jin, Ji Yeon Seo, Ji Min Choi, Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 135-984, South Korea.
authors.forename: Ji Yeon
authors.initials: JY
authors.lastname: Seo
authors.affiliation: Eun Hyo Jin, Ji Yeon Seo, Ji Min Choi, Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 135-984, South Korea.
authors.forename: Ji Min
authors.initials: JM
authors.lastname: Choi
authors.affiliation: Eun Hyo Jin, Ji Yeon Seo, Ji Min Choi, Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 135-984, South Korea.
authors.forename: Jaeyoung
authors.initials: J
authors.lastname: Chun
authors.affiliation: Eun Hyo Jin, Ji Yeon Seo, Ji Min Choi, Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 135-984, South Korea.
authors.forename: Sang Gyun
authors.initials: SG
authors.lastname: Kim
authors.affiliation: Eun Hyo Jin, Ji Yeon Seo, Ji Min Choi, Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 135-984, South Korea.
authors.forename: Joo Sung
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Eun Hyo Jin, Ji Yeon Seo, Ji Min Choi, Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 135-984, South Korea.
authors.forename: Hyun Chae
authors.initials: HC
authors.lastname: Jung
mesh_terms: D000367:Age Factors; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D003113:Colonoscopy / Q000009:adverse effects* / Q000379:methods; D016292:Procedural Sedation / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam
keywords: Conscious sedation; Endoscopy; Midazolam; Patient satisfaction; Surveys and questionnaires