Nam Ji Hyung, Jang Dong Kee, Lee Jun Kyu, Kang Hyoun Woo, Kim Byung-Wook, Jang Byung Ik
Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.
Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
Clin Endosc. 2022 Mar;55(2):234-239. doi: 10.5946/ce.2021.126. Epub 2021 Oct 12.
BACKGROUND/AIMS: The efficacy of propofol in gastrointestinal endoscopy for patients with midazolam-induced paradoxical reactions remains unclarified. This study aimed to compare the efficacy and safety of propofol-based sedation in patients who previously experienced paradoxical reactions.
This was a prospective, single-blinded, randomized controlled pilot study. Participants with a history of paradoxical reactions to midazolam during a previous esophagogastroduodenoscopy were recruited and randomly assigned to group I (propofol monosedation) or group II (combination of propofol and midazolam). The primary endpoint was the occurrence of a paradoxical reaction.
A total of 30 participants (mean age, 54.7±12.6 years; male, 19/30) were randomly assigned to group I (n=16) or group II (n=14). There were no paradoxical reactions in group I, but there were two in group II, without a significant difference (p=0.209). The mean dose of propofol was higher in group I than in group II (p=0.002). Meanwhile, the procedure and recovery times did not differ between groups.
Propofol-based sedation was safe and effective for patients who experienced paradoxical reactions to midazolam. However, caution is needed because few cases of paradoxical reaction again can happen in group II in which midazolam was readministered.
背景/目的：对于咪达唑仑诱发反常反应的患者，丙泊酚用于胃肠内镜检查的疗效尚不清楚。本研究旨在比较曾发生反常反应的患者使用丙泊酚镇静的疗效和安全性。
这是一项前瞻性、单盲、随机对照试验性研究。招募既往在食管胃十二指肠镜检查期间对咪达唑仑有反常反应史的参与者，并将其随机分为I组（丙泊酚单一镇静）或II组（丙泊酚与咪达唑仑联合使用）。主要终点是反常反应的发生情况。
共有30名参与者（平均年龄54.7±12.6岁；男性19/30）被随机分配到I组（n = 16）或II组（n = 14）。I组未发生反常反应，II组有2例，差异无统计学意义（p = 0.209）。I组丙泊酚的平均剂量高于II组（p = 0.002）。同时，两组的操作时间和恢复时间无差异。
对于曾对咪达唑仑发生反常反应的患者，丙泊酚镇静是安全有效的。然而，由于再次给予咪达唑仑的II组仍有少数患者再次发生反常反应，因此需要谨慎使用。
