Gastrointestinal endoscopy
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Gastrointest. Endosc. · Jan 1998
Randomized Controlled Trial Comparative Study Clinical TrialMidazolam versus diazepam in lipid emulsion as conscious sedation for colonoscopy with or without reversal of sedation with flumazenil.
The efficacy and tolerance of midazolam (Dormicum R) versus diazepam in lipid emulsion (Diazemuls R, Dumex) was evaluated in a randomized, controlled, double-blind trial in 200 patients undergoing total colonoscopy. ⋯ We conclude that midazolam can be used safely in relatively fit patients between 17 and 65 years old and that it is the drug of choice if amnesia is desirable. As sole premedication this drug was insufficient in 42% of the patients (pain score was greater than 3), especially in young women.
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Gastrointest. Endosc. · Jan 1997
Randomized Controlled Trial Clinical TrialSedation and analgesia for colonoscopy: patient tolerance, pain, and cardiorespiratory parameters.
Colonoscopy is generally performed with the patient sedated and receiving analgesics. However, the benefit of the most often used combination of intravenous midazolam and pethidine on patient tolerance and pain and its cardiorespiratory risk have not been fully defined. ⋯ In this study, the combination of low-dose midazolam and pethidine does not improve patient tolerance and lessen pain during colonoscopy as compared with either drug given alone. When applying low-dose midazolam, oxygen desaturation and hypotension do not occur more often after combined use of both drugs. For the individual patient, sedation and analgesia should be based on the endoscopist's clinical judgement.
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Gastrointest. Endosc. · Jan 1997
Randomized Controlled Trial Clinical TrialNitrous oxide inhalation as sedation for flexible sigmoidoscopy.
Flexible sigmoidoscopy is usually performed without sedation in screening programs for colorectal cancer. Most patients report some degree of discomfort or pain during the procedure. The aim of this study was to evaluate self-administered nitrous oxide as a method to reduce patient discomfort, thereby improving the procedure and conceivably increasing patient compliance and motivation. ⋯ The addition of "on demand" nitrous oxide did not improve sigmoidoscopy performance or diminish pain and discomfort. However, further studies using improved administration techniques and larger study groups are justified in the search for ways to increase compliance with and motivation for colorectal cancer screening.
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Gastrointest. Endosc. · Oct 1996
Randomized Controlled Trial Clinical TrialFlumazenil reversal of psychomotor impairment due to midazolam or diazepam for conscious sedation for upper endoscopy.
Flumazenil is a competitive benzodiazepine antagonist that acts to reverse their sedative and hypnotic effects. It is indicated in the management of benzodiazepine overdose, but its role in the routine reversal of endoscopic conscious sedation has not been defined. ⋯ These results demonstrate that flumazenil's effects on reversing psychomotor impairment are similar when midazolam or diazepam are used for conscious sedation. However, the potential usefulness of routine flumazenil reversal of conscious sedation will require further evaluation of specific psychomotor performance skills (such as driving a car) before we lift the admonition against leaving the endoscopic suite unattended, driving a vehicle, or operating complicated machinery for several hours.
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Gastrointest. Endosc. · May 1996
Randomized Controlled Trial Comparative Study Clinical TrialPatient-controlled analgesia for conscious sedation during endoscopic retrograde cholangiopancreatography: a randomized controlled trial.
Adequate comfort is essential to patients undergoing invasive procedures. This study was designed to evaluate whether patient-controlled analgesia could improve sedation for ERCP. ⋯ This trial demonstrates that patient-controlled analgesia during ERCP is as effective as standard sedation with respect to patient satisfaction. Physicians and nurses, however, are not good proxies for assessing patient satisfaction.