Skip to main content
PMC home page
British Journal of Clinical Pharmacology logoLink to British Journal of Clinical Pharmacology
. 1988 Nov;26(5):595–600. doi: 10.1111/j.1365-2125.1988.tb05300.x

A comparison of diazepam and midazolam as endoscopy premedication assessing changes in ventilation and oxygen saturation.

G D Bell 1, A Morden 1, T Coady 1, J Lee 1, R F Logan 1
PMCID: PMC1386637  PMID: 3061425

Abstract

1. One hundred and two consecutive patients undergoing upper gastrointestinal endoscopy were randomised to be sedated with either intravenous diazepam (Diazemuls-Kabi Vitrum) or intravenous midazolam (Hypnovel-Roche). It was assumed that midazolam was likely to be approximately twice as potent as diazepam on the basis of previous work. 2. All patients had an ear oximeter attached throughout the procedure to record continuously their level of oxygen saturation. 3. All 102 patients had pre-endoscopy respiratory function tests measured and 100 wore an induction plethysmograph vest to allow continuous estimation of respiratory rate and excursion. The plethysmograph was calibrated using a pneumotachygraph, so baseline, post-injection and post-endoscopy minute volumes could be estimated. 4. The age, sex ratio and pre-endoscopy respiratory function tests of the 51 patients given intravenous diazepam in a mean dose (s.d.) of 11.5 (5.8) mg over a mean of 3.4 (0.9) min) were similar to that of the 51 patients sedated with intravenous midazolam (mean dose 6.0 (2.8) mg over 3.3 (0.9) min. 5. Both drugs significantly reduced minute volume (P less than 0.001) and oxygen saturation (P less than 0.001). Midazolam appeared to produce slightly greater hypoxaemia with 57% having falls in oxygen saturation of greater than 2.5% compared with only 35% given an equivalent dose of diazepam. 6. Ventilation was still less than baseline when re-checked some minutes after removal of the gastroscope. The speed of recovery appeared faster after diazepam sedation which is in contrast to its longer pharmacological half-life.(ABSTRACT TRUNCATED AT 250 WORDS)

Full text

PDF
595

Selected References

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

  1. Al-Khudhairi D., Whitwam J. G., McCloy R. F. Midazolam and diazepam for gastroscopy. Anaesthesia. 1982 Oct;37(10):1002–1006. doi: 10.1111/j.1365-2044.1982.tb01712.x. [DOI] [PubMed] [Google Scholar]
  2. Bardhan K. D., Morris P., Taylor P. C., Hinchliffe R. F., Harris P. A. Intravenous sedation for upper gastrointestinal endoscopy: diazepam versus midazolam. Br Med J (Clin Res Ed) 1984 Apr 7;288(6423):1046–1046. doi: 10.1136/bmj.288.6423.1046. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bell G. D., Bown S., Morden A., Coady T., Logan R. F. Prevention of hypoxaemia during upper-gastrointestinal endoscopy by means of oxygen via nasal cannulae. Lancet. 1987 May 2;1(8540):1022–1024. doi: 10.1016/s0140-6736(87)92282-3. [DOI] [PubMed] [Google Scholar]
  4. Bell G. D., Reeve P. A., Moshiri M., Morden A., Coady T., Stapleton P. J., Logan R. F. Intravenous midazolam: a study of the degree of oxygen desaturation occurring during upper gastrointestinal endoscopy. Br J Clin Pharmacol. 1987 Jun;23(6):703–708. doi: 10.1111/j.1365-2125.1987.tb03104.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. 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]
  6. Berggren L., Eriksson I., Mollenholt P., Wickbom G. Sedation for fibreoptic gastroscopy: a comparative study of midazolam and diazepam. Br J Anaesth. 1983 Apr;55(4):289–296. doi: 10.1093/bja/55.4.289. [DOI] [PubMed] [Google Scholar]
  7. Brophy T., Dundee J. W., Heazelwood V., Kawar P., Varghese A., Ward M. Midazolam, a water-soluble benzodiazepine, for gastroscopy. Anaesth Intensive Care. 1982 Nov;10(4):344–347. doi: 10.1177/0310057X8201000409. [DOI] [PubMed] [Google Scholar]
  8. Bullimore D. W., Mulley B. A., Cooke P., Miloszewski K. J. Comparison of the effectiveness of midazolam and diazepam in lipid emulsion as sedation during upper gastrointestinal endoscopy. Aliment Pharmacol Ther. 1987 Oct;1(5):409–414. doi: 10.1111/j.1365-2036.1987.tb00641.x. [DOI] [PubMed] [Google Scholar]
  9. Cole S. G., Brozinsky S., Isenberg J. I. Midazolam, a new more potent benzodiazepine, compared with diazepam: a randomized, double-blind study of preendoscopic sedatives. Gastrointest Endosc. 1983 Aug;29(3):219–222. doi: 10.1016/s0016-5107(83)72588-5. [DOI] [PubMed] [Google Scholar]
  10. Davis R. E., Graham D. Y. Endoscopic complications: the Texas experience. Gastrointest Endosc. 1979 Nov;25(4):146–149. doi: 10.1016/s0016-5107(79)73405-5. [DOI] [PubMed] [Google Scholar]
  11. Dundee J. W., Halliday N. J., Harper K. W., Brogden R. N. Midazolam. A review of its pharmacological properties and therapeutic use. Drugs. 1984 Dec;28(6):519–543. doi: 10.2165/00003495-198428060-00002. [DOI] [PubMed] [Google Scholar]
  12. Green J. R., Ravenscroft M. M., Swan C. H. Diazepam or midazolam for endoscopy? Br Med J (Clin Res Ed) 1984 May 5;288(6427):1383–1383. doi: 10.1136/bmj.288.6427.1383. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hamdy N. A., Kennedy H. J., Nicholl J., Triger D. R. Sedation for gastroscopy: a comparative study of midazolam and Diazemuls in patients with and without cirrhosis. Br J Clin Pharmacol. 1986 Dec;22(6):643–647. doi: 10.1111/j.1365-2125.1986.tb02952.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Katon R. M. Complications of upper gastrointestinal endoscopy in the gastrointestinal bleeder. Dig Dis Sci. 1981 Jul;26(7 Suppl):47S–54S. doi: 10.1007/BF01300807. [DOI] [PubMed] [Google Scholar]
  15. Kawar P., Porter K. G., Hunter E. K., McLaughlin J., Dundee J. W., Brophy T. O. Midazolam for upper gastrointestinal endoscopy. Ann R Coll Surg Engl. 1984 Jul;66(4):283–285. [PMC free article] [PubMed] [Google Scholar]
  16. Levy N., Abinader E. Continuous electrocardiographic monitoring with Holter electrocardiocorder throughout all stages of gastroscopy. Am J Dig Dis. 1977 Dec;22(12):1091–1096. doi: 10.1007/BF01072863. [DOI] [PubMed] [Google Scholar]
  17. Lieberman D. A., Wuerker C. K., Katon R. M. Cardiopulmonary risk of esophagogastroduodenoscopy. Role of endoscope diameter and systemic sedation. Gastroenterology. 1985 Feb;88(2):468–472. doi: 10.1016/0016-5085(85)90508-6. [DOI] [PubMed] [Google Scholar]
  18. Magni V. C., Frost R. A., Leung J. W., Cotton P. B. A randomized comparison of midazolam and diazepam for sedation in upper gastrointestinal endoscopy. Br J Anaesth. 1983 Nov;55(11):1095–1101. doi: 10.1093/bja/55.11.1095. [DOI] [PubMed] [Google Scholar]
  19. Mathew P. K., Ona F. V., Damevski K., Wallace W. A. Arrhythmias during upper gastrointestinal endoscopy. Angiology. 1979 Dec;30(12):834–840. doi: 10.1177/000331977903001207. [DOI] [PubMed] [Google Scholar]
  20. Ona F. V., Israel R. H. The effect of gastroscopy on arterial blood gases. Am J Proctol Gastroenterol Colon Rectal Surg. 1981 Dec;32(12):8–11. [PubMed] [Google Scholar]
  21. Pecora A. A., Chiesa J. C., Alloy A. M., Santoro J., Lazarus B. The effect of upper gastrointestinal endoscopy on arterial O2 tension in smokers and nonsmokers with and without premedication. Gastrointest Endosc. 1984 Oct;30(5):284–288. doi: 10.1016/s0016-5107(84)72419-9. [DOI] [PubMed] [Google Scholar]
  22. Rostykus P. S., McDonald G. B., Albert R. K. Upper intestinal endoscopy induces hypoxemia in patients with obstructive pulmonary disease. Gastroenterology. 1980 Mar;78(3):488–491. [PubMed] [Google Scholar]
  23. Rozen P., Fireman Z., Gilat T. Arterial oxygen tension changes in elderly patients undergoing upper gastrointestinal endoscopy. II. Influence of the narcotic premedication and endoscope diameter. Scand J Gastroenterol. 1981;16(2):299–303. doi: 10.3109/00365528109181972. [DOI] [PubMed] [Google Scholar]
  24. Rozen P., Fireman Z., Gilat T. The causes of hypoxemia in elderly patients during endoscopy. Gastrointest Endosc. 1982 Nov;28(4):243–246. doi: 10.1016/s0016-5107(82)73101-3. [DOI] [PubMed] [Google Scholar]
  25. Schiller K. F., Cotton P. B., Salmon P. R. The hazards of digestive fibre-endoscopy: a survey of British experience. Gut. 1972 Dec;13(12):1027–1027. [PubMed] [Google Scholar]
  26. Silvis S. E., Nebel O., Rogers G., Sugawa C., Mandelstam P. Endoscopic complications. Results of the 1974 American Society for Gastrointestinal Endoscopy Survey. JAMA. 1976 Mar 1;235(9):928–930. doi: 10.1001/jama.235.9.928. [DOI] [PubMed] [Google Scholar]
  27. Taylor P. A., Cotton P. B., Towey R. M., Gent A. E. Pulmonary complications after oesophagogastroscopy using diazepam. Br Med J. 1972 Mar 11;1(5801):666–666. doi: 10.1136/bmj.1.5801.666. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. 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]
  29. Whorwell P. J., Smith C. L., Foster K. J. Arterial blood gas tensions during upper gastrointestinal endoscopy. Gut. 1976 Oct;17(10):797–800. doi: 10.1136/gut.17.10.797. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from British Journal of Clinical Pharmacology are provided here courtesy of British Pharmacological Society

RESOURCES