Pediatr Gastroenterol Hepatol Nutr.  2019 May;22(3):217-224. 10.5223/pghn.2019.22.3.217.

Propofol with and without Midazolam for Diagnostic Upper Gastrointestinal Endoscopies in Children

Affiliations
  • 1Department of Pediatric Gastroenterology Hepatology and Nutrition, University of Health Sciences, Antalya Education and Research Hospital, Antalya, Turkey. ulasemre@hotmail.com
  • 2Department of Anesthesiology and Intensive Care Medicine, University of Health Sciences, Kanuni Training and Research Hospital, Trabzon, Turkey.
  • 3Department of Pediatric Gastroenterology Hepatology and Nutrition, University of Health Sciences, Kanuni Training and Research Hospital, Trabzon, Turkey.

Abstract

PURPOSE
Various publications on the use of sedation and anesthesia for diagnostic procedures in children have demonstrated that no ideal agent is available. Although propofol has been widely used for sedation during esophagogastroduodenoscopy in children, adverse events including hypoxia and hypotension, are concerns in propofol-based sedation. Propofol is used in combination with other sedatives in order to reduce potential complications. We aimed to analyze whether the administration of midazolam would improve the safety and efficacy of propofol-based sedation in diagnostic esophagogastroduodenoscopies in children.
METHODS
We retrospectively reviewed the hospital records of children who underwent diagnostic esophagogastroduodenoscopies during a 30-month period. Demographic characteristics, vital signs, medication dosages, induction times, sedation times, recovery times, and any complications observed, were examined.
RESULTS
Baseline characteristics did not differ between the midazolam-propofol and propofol alone groups. No differences were observed between the two groups in terms of induction times, sedation times, recovery times, or the proportion of satisfactory endoscopist responses. No major procedural complications, such as cardiac arrest, apnea, or laryngospasm, occurred in any case. However, minor complications developed in 22 patients (10.7%), 17 (16.2%) in the midazolam-propofol group and five (5.0%) in the propofol alone group (p=0.010).
CONCLUSION
The sedation protocol with propofol was safe and efficient. The administration of midazolam provided no additional benefit in propofol-based sedation.

Keyword

Conscious sedation; Endoscopy; Propofol; Midazolam; Children

MeSH Terms

Anesthesia
Anoxia
Apnea
Child*
Conscious Sedation
Endoscopy
Endoscopy, Digestive System
Endoscopy, Gastrointestinal*
Heart Arrest
Hospital Records
Humans
Hypnotics and Sedatives
Hypotension
Laryngismus
Midazolam*
Propofol*
Retrospective Studies
Vital Signs
Hypnotics and Sedatives
Midazolam
Propofol

Reference

1. Abraham NS, Fallone CA, Mayrand S, Huang J, Wieczorek P, Barkun AN. Sedation versus no sedation in the performance of diagnostic upper gastrointestinal endoscopy: a Canadian randomized controlled cost-outcome study. Am J Gastroenterol. 2004; 99:1692–1699.
Article
2. van Beek EJ, Leroy PL. Safe and effective procedural sedation for gastrointestinal endoscopy in children. J Pediatr Gastroenterol Nutr. 2012; 54:171–185.
Article
3. Isik IA, Iyilikçi L, Ozturk Y, Adiyaman E. Sedation practice outside the operating room for pediatric gastrointestinal endoscopy. Indian Pediatr. 2015; 52:989–990.
Article
4. Dewitt J, McGreevy K, Sherman S, Imperiale TF. Nurse-administered propofol sedation compared with midazolam and meperidine for EUS: a prospective, randomized trial. Gastrointest Endosc. 2008; 68:499–509.
Article
5. Heuss LT, Schnieper P, Drewe J, Pflimlin E, Beglinger C. Safety of propofol for conscious sedation during endoscopic procedures in high-risk patients-a prospective, controlled study. Am J Gastroenterol. 2003; 98:1751–1757.
Article
6. Tohda G, Higashi S, Wakahara S, Morikawa M, Sakumoto H, Kane T. Propofol sedation during endoscopic procedures: safe and effective administration by registered nurses supervised by endoscopists. Endoscopy. 2006; 38:360–367.
Article
7. Akbulut UE, Saylan S, Sengu B, Akcali GE, Erturk E, Cakir M. A comparison of sedation with midazolam-ketamine versus propofol-fentanyl during endoscopy in children: a randomized trial. Eur J Gastroenterol Hepatol. 2017; 29:112–118.
Article
8. Kim EH, Park JC, Shin SK, Lee YC, Lee SK. Effect of the midazolam added with propofol-based sedation in esophagogastroduodenoscopy: a randomized trial. J Gastroenterol Hepatol. 2018; 33:894–899.
Article
9. Akbulut UE, Cakir M. Efficacy and safety of low dose ketamine and midazolam combination for diagnostic upper gastrointestinal endoscopy in children. Pediatr Gastroenterol Hepatol Nutr. 2015; 18:160–167.
Article
10. Triantafillidis JK, Merikas E, Nikolakis D, Papalois AE. Sedation in gastrointestinal endoscopy: current issues. World J Gastroenterol. 2013; 19:463–481.
Article
11. Horn E, Nesbit SA. Pharmacology and pharmacokinetics of sedatives and analgesics. Gastrointest Endosc Clin N Am. 2004; 14:247–268.
Article
12. Lowrie L, Weiss AH, Lacombe C. The pediatric sedation unit: a mechanism for pediatric sedation. Pediatrics. 1998; 102:E30.
Article
13. De Silva AP, Amarasiri L, Liyanage MN, Kottachchi D, Dassanayake AS, de Silva HJ. One-hour fast for water and six-hour fast for solids prior to endoscopy provides good endoscopic vision and results in minimum patient discomfort. J Gastroenterol Hepatol. 2009; 24:1095–1097.
Article
14. Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. BMJ. 1974; 2:656–659.
Article
15. Aldrete JA. Modifications to the postanesthesia score for use in ambulatory surgery. J Perianesth Nurs. 1998; 13:148–155.
16. VanNatta ME, Rex DK. Propofol alone titrated to deep sedation versus propofol in combination with opioids and/or benzodiazepines and titrated to moderate sedation for colonoscopy. Am J Gastroenterol. 2006; 101:2209–2217.
Article
17. Lazzaroni M, Bianchi Porro G. Preparation, premedication and surveillance. Endoscopy. 2003; 35:103–111.
Article
18. Disma N, Astuto M, Rizzo G, Rosano G, Naso P, Aprile G, et al. Propofol sedation with fentanyl or midazolam during oesophagogastroduodenoscopy in children. Eur J Anaesthesiol. 2005; 22:848–852.
Article
19. Vargo JJ, Cohen LB, Rex DK, Kwo PY, et al. American Association for the Study of Liver Diseases. American College of Gasteroenterology. Position statement: Nonanesthesiologist administration of propofol for GI endoscopy. Gastroenterology. 2009; 137:2161–2167.
Article
20. Cohen LB, Hightower CD, Wood DA, Miller KM, Aisenberg J. Moderate level sedation during endoscopy: a prospective study using low-dose propofol, meperidine/fentanyl, and midazolam. Gastrointest Endosc. 2004; 59:795–803.
Article
21. McQuaid KR, Laine L. A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures. Gastrointest Endosc. 2008; 67:910–923.
Article
22. Byrne MF, Chiba N, Singh H, Sadowski DC. Clinical Affairs Committee of the Canadian Association of Gastroenterology. Propofol use for sedation during endoscopy in adults: a Canadian Association of Gastroenterology position statement. Can J Gastroenterol. 2008; 22:457–459.
Article
23. Simsek M, Bulut MO, Ozel D, Yucel IK, Aykac Z. Comparison of sedation method in pediatrics cardiac catheterization. Eur Rev Med Pharmacol Sci. 2016; 20:1490–1494.
24. Lamireau T, Dubreuil M, Daconceicao M. Oxygen saturation during esophagogastroduodenoscopy in children: general anesthesia versus intravenous sedation. J Pediatr Gastroenterol Nutr. 1998; 27:172–175.
Article
25. Olkkola KT, Ahonen J. Midazolam and other benzodiazepines. Handb Exp Pharmacol. 2008; 182:335–360.
Article
26. Hari Keerthy P, Balakrishna R, Srungeri KM, Singhvi N, John J, Islam M. Comparitive evaluation of propofol and midazolam as conscious sedatives in minor oral surgery. J Maxillofac Oral Surg. 2015; 14:773–783.
Article
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