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. 1993 Dec;36(6):573–578. doi: 10.1111/j.1365-2125.1993.tb00417.x

Small bolus injections of intravenous midazolam for upper gastrointestinal endoscopy: a study of 788 consecutive cases.

M R Smith 1, G D Bell 1, M A Quine 1, G M Spencer 1, A E Morden 1, J G Jones 1
PMCID: PMC1364663  PMID: 12959275

Abstract

1 A recent audit of upper gastrointestinal endoscopy carried out by the Royal College of Surgeons of England has shown that the majority of endoscopists use a bolus injection rather than a slow intravenous titration of benzodiazepine for intravenous sedation. In this study we have confirmed the theoretical premise that a reduced dose of midazolam is required when given as a bolus. A mean dose of 4.65 mg midazolam intravenously has been found to be effective and safe in sedating patients under 70 years (n = 552). The dose of midazolam needed is reduced in older patients: patients over 70 years (n = 236) needed a mean dose of 1.89 mg. 2 Topical pharyngeal anaesthesia was not required with these doses of midazolam, and it was our impression that the examination was equally well tolerated with a similar degree of anterograde amnesia as in the previous study. 3 Our data, together with the results of the audit, would suggest many endoscopists are employing unnecessarily large and at times potentially dangerous doses of intravenous sedation in elderly patients and that the vast majority of upper gastrointestinal endoscopies can be performed successfully, without topical pharyngeal anaesthesia, using a bolus injection techniquewith a reduced dosage of sedative agent.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arrowsmith J. B., Gerstman B. B., Fleischer D. E., Benjamin S. B. Results from the American Society for Gastrointestinal Endoscopy/U.S. Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy. Gastrointest Endosc. 1991 Jul-Aug;37(4):421–427. doi: 10.1016/s0016-5107(91)70773-6. [DOI] [PubMed] [Google Scholar]
  2. Aun C., Flynn P. J., Richards J., Major E. A comparison of midazolam and diazepam for intravenous sedation in dentistry. Anaesthesia. 1984 Jun;39(6):589–593. doi: 10.1111/j.1365-2044.1984.tb07370.x. [DOI] [PubMed] [Google Scholar]
  3. Aveling W., Bradshaw A. D., Crankshaw D. P. The effect of speed of injection on the potency of anaesthetic induction agents. Anaesth Intensive Care. 1978 May;6(2):116–119. doi: 10.1177/0310057X7800600202. [DOI] [PubMed] [Google Scholar]
  4. Bell G. D., Antrobus J. H., Lee J., Coady T., Morden A. Bolus or slow titrated injection of midazolam prior to upper gastrointestinal endoscopy? Relative effect on oxygen saturation and prophylactic value of supplemental oxygen. Aliment Pharmacol Ther. 1990 Aug;4(4):393–401. doi: 10.1111/j.1365-2036.1990.tb00485.x. [DOI] [PubMed] [Google Scholar]
  5. Bell G. D., McCloy R. F., Charlton J. E., Campbell D., Dent N. A., Gear M. W., Logan R. F., Swan C. H. Recommendations for standards of sedation and patient monitoring during gastrointestinal endoscopy. Gut. 1991 Jul;32(7):823–827. doi: 10.1136/gut.32.7.823. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Bell G. D., Quine A., Antrobus J. H., Morden A., Burridge S. M., Coady T. J., Lee J. Upper gastrointestinal endoscopy: a prospective randomized study comparing continuous supplemental oxygen via the nasal or oral route. Gastrointest Endosc. 1992 May-Jun;38(3):319–325. doi: 10.1016/s0016-5107(92)70424-6. [DOI] [PubMed] [Google Scholar]
  7. Bell G. D., Spickett G. P., Reeve P. A., Morden A., Logan R. F. Intravenous midazolam for upper gastrointestinal endoscopy: a study of 800 consecutive cases relating dose to age and sex of patient. Br J Clin Pharmacol. 1987 Feb;23(2):241–243. doi: 10.1111/j.1365-2125.1987.tb03037.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Ben-Shlomo I., abd-el-Khalim H., Ezry J., Zohar S., Tverskoy M. Midazolam acts synergistically with fentanyl for induction of anaesthesia. Br J Anaesth. 1990 Jan;64(1):45–47. doi: 10.1093/bja/64.1.45. [DOI] [PubMed] [Google Scholar]
  9. Bührer M., Maitre P. O., Crevoisier C., Stanski D. R. Electroencephalographic effects of benzodiazepines. II. Pharmacodynamic modeling of the electroencephalographic effects of midazolam and diazepam. Clin Pharmacol Ther. 1990 Nov;48(5):555–567. doi: 10.1038/clpt.1990.192. [DOI] [PubMed] [Google Scholar]
  10. Chuah S. Y., Crowson C. P., Dronfield M. W. Topical anaesthesia in upper gastrointestinal endoscopy. BMJ. 1991 Sep 21;303(6804):695–695. doi: 10.1136/bmj.303.6804.695. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Crankshaw D. P., Rosler A., Ware M. The short term distribution of thiopentone in the dog. Anaesth Intensive Care. 1979 May;7(2):148–151. doi: 10.1177/0310057X7900700206. [DOI] [PubMed] [Google Scholar]
  12. Galletly D., Forrest P., Purdie G. Comparison of the recovery characteristics of diazepam and midazolam. Br J Anaesth. 1988 Apr;60(5):520–524. doi: 10.1093/bja/60.5.520. [DOI] [PubMed] [Google Scholar]
  13. Halim B., Schneider I., Claeys M. A., Camu F. The use of midazolam and flumazenil in locoregional anaesthesia: an overview. Acta Anaesthesiol Scand Suppl. 1990;92:42–46. doi: 10.1111/j.1399-6576.1990.tb03181.x. [DOI] [PubMed] [Google Scholar]
  14. Hart R., Classen M. Complications of diagnostic gastrointestinal endoscopy. Endoscopy. 1990 Sep;22(5):229–233. doi: 10.1055/s-2007-1010734. [DOI] [PubMed] [Google Scholar]
  15. Korttila K., Tarkkanen J. Comparison of diazepam and midazolam for sedation during local anaesthesia for bronchoscopy. Br J Anaesth. 1985 Jun;57(6):581–586. doi: 10.1093/bja/57.6.581. [DOI] [PubMed] [Google Scholar]
  16. Nuotto E. J., Korttila K. T., Lichtor J. L., Ostman P. L., Rupani G. Sedation and recovery of psychomotor function after intravenous administration of various doses of midazolam and diazepam. Anesth Analg. 1992 Feb;74(2):265–271. doi: 10.1213/00000539-199202000-00017. [DOI] [PubMed] [Google Scholar]
  17. Swain D. G., Ellis D. J., Bradby H. Rapid intravenous low-dose diazepam as sedation for upper gastrointestinal endoscopy. Aliment Pharmacol Ther. 1990 Feb;4(1):43–48. doi: 10.1111/j.1365-2036.1990.tb00447.x. [DOI] [PubMed] [Google Scholar]
  18. Tverskoy M., Fleyshman G., Ezry J., Bradley E. L., Jr, Kissin I. Midazolam-morphine sedative interaction in patients. Anesth Analg. 1989 Mar;68(3):282–285. [PubMed] [Google Scholar]
  19. Vinik H. R., Bradley E. L., Jr, Kissin I. Midazolam-alfentanil synergism for anesthetic induction in patients. Anesth Analg. 1989 Aug;69(2):213–217. [PubMed] [Google Scholar]
  20. Whitwam J. G., Al-Khudhairi D., McCloy R. F. Comparison of midazolam and diazepam in doses of comparable potency during gastroscopy. Br J Anaesth. 1983 Aug;55(8):773–777. doi: 10.1093/bja/55.8.773. [DOI] [PubMed] [Google Scholar]

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