Optimal midazolam dose, factors affecting midazolam dose and proper timing of flumazenil injection during esophagogastroduodenoscopy

Suh, Jung Yul; Yun, Jung Won; Kim, Jeong Wook; Park, Dong Il; Lee, Jun Haeng; Cho, Yong Kyun; Park, Chang Young; Sung, In Kyung; Sohn, Chong Il; Jeon, Woo Kyu; Kim, Byung Ik; Oh, Suk Joong; Shin, Young Chul

Abstract

BACKGROUND: Intravenous administration of midazolam is widely used as a premedication for esophagogastroduonenoscopy. However, there are individual differences in midazolam doses for premedication and controversies for starting point of esophagogastroduonenoscopy after midazolam injection. There are also controversies for flumazenil injection time after esophagogastroduonenoscopy. The aims of this study were to determine the proper doses of midazolam for esophagogastroduonenoscopy and factors which affect midazolam doses. Also we evaluated the proper timing of flumazenil injection to increase patient's satisfaction according to sedation status.
METHODS
126 patients who were supposed to be taken diagnostic esophagogastroduonenoscopic exam were enrolled in this study. We evaluated the difference of patient's age, sex, alcohol consumption, sedation score, cooperation score, and satisfaction score according to midazolam doses. The relation between midazolam doses and agitation score, insomnia score, and somatic preoccupation score were checked. We evaluated the relation between midazolam doses and age, sex, alcohol consumption, amnesia, sedation, cooperation and satisfaction.
RESULTS
There were no relationship between age, sex and midazolam doses. Alcoholics needed larger amount of midazolam than non-alcoholics. No differences in satisfaction were observed according to sedation status. There were significant relationship between midazolam doses and sedation score but not with satisfaction, cooperation, amnesia, agitation, insomnia and somatic preoccupation score. Patients who were injected flumazenil 20 minutes after esophagogastroduonenoscopy were more satisfied than patients who were injected flumazenil immediately after esophagogastroduonenoscopy.
CONCLUSION
Minimal doses of midazolam that could induce mild sedation was enough and safe. Flumazenil injection 20 minutes after esophagogastroduonenoscopy was more efficacious than immediate injection.