Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
J Gastroenterol Hepatol. 2018 Apr;33(4):894-899. doi: 10.1111/jgh.14026. Epub 2018 Feb 6.
Although propofol has been widely used for sedation during esophagogastroduodenoscopy (EGD), adverse events including hypoxia and hypotension may be a concern in the propofol-based sedation. We aimed to analyze whether administration of midazolam would improve safety and efficacy of propofol-based sedation in EGD.
One hundred twenty patients who were scheduled to undergo diagnostic EGD were randomly assigned to either midazolam plus propofol (MP) or propofol alone groups. In the MP group, 2 mg of midazolam and 10 mg of propofol were given initially. In the propofol alone group, 40-60 mg of propofol was given initially. In both groups, 20 mg of propofol was given repeatedly to maintain moderate sedation as needed. Vital signs including oxygen saturation were monitored every 2 min. After the patients fully recovered, satisfaction score was investigated from endoscopists, nurses, and patients, respectively.
The baseline characteristics did not differ between the MP and propofol alone groups. The mean required doses of propofol was (mean ± standard deviation) 0.3 ± 0.3 and 0.8 ± 0.2 mg/kg in the MP and propofol alone groups, respectively (P < 0.001). In addition, sedation-related adverse events and recovery time did not differ between the two groups. The proportion of satisfactory did not differ between the two groups (MP vs propofol alone; proportion; patient, 95.0% vs 93.3%, P > 0.999; endoscopist, 73.3% vs 80.0%, P = 0.064; nurse, 73.3% vs 76.7%, P = 0.551).
Adding midazolam to propofol did not reduced the safety and efficacy, and sedation using propofol alone could be suitable for sedation during diagnostic EGD.
尽管丙泊酚已广泛用于食管胃十二指肠镜检查（EGD）中的镇静，但在丙泊酚镇静中，可能会出现包括缺氧和低血压在内的不良事件。我们旨在分析咪达唑仑给药是否会提高 EGD 中丙泊酚镇静的安全性和疗效。
将 120 例拟行诊断性 EGD 的患者随机分为咪达唑仑加丙泊酚（MP）组或丙泊酚组。在 MP 组中，最初给予 2 mg 咪达唑仑和 10 mg 丙泊酚。在丙泊酚组中，最初给予 40-60 mg 丙泊酚。在两组中，根据需要重复给予 20 mg 丙泊酚以维持中度镇静。每 2 分钟监测一次生命体征，包括氧饱和度。患者完全恢复后，分别由内镜医师、护士和患者调查满意度评分。
MP 组和丙泊酚组的基线特征无差异。MP 组和丙泊酚组丙泊酚的平均需要剂量分别为（均数±标准差）0.3±0.3 和 0.8±0.2 mg/kg（P<0.001）。此外，两组镇静相关不良事件和恢复时间无差异。两组的满意度比例也无差异（MP 与丙泊酚组；患者，95.0%比 93.3%，P>0.999；内镜医师，73.3%比 80.0%，P=0.064；护士，73.3%比 76.7%，P=0.551）。
在丙泊酚中加入咪达唑仑并未降低安全性和疗效，单独使用丙泊酚镇静可适用于诊断性 EGD 中的镇静。
