TY - JOUR
T1 - Paradoxical reaction to midazolam in patients undergoing endoscopy under sedation
T2 - Incidence, risk factors and the effect of flumazenil
AU - Tae, Chung Hyun
AU - Kang, Ki Joo
AU - Min, Byung Hoon
AU - Ahn, Joong Hyun
AU - Kim, Seonwoo
AU - Lee, Jun Haeng
AU - Rhee, Poong Lyul
AU - Kim, Jae J.
PY - 2014/8
Y1 - 2014/8
N2 - Background: The incidence, risk factors and management strategy of paradoxical reaction to midazolam during endoscopy are yet to be clarified. Methods: This single center prospective study included 4140 adult patients (2263 males, mean age of 57.7 ± 12.6) undergoing endoscopy under sedation with midazolam and pethidine between September 2011 and December 2011. The characteristics of patients with and without paradoxical reaction were compared. For patients who experienced paradoxical reaction and received flumazenil, their endoscopic images were reviewed to assess whether European Society of Gastrointestinal Endoscopy guidelines were met as quality indicator of endoscopy. Results: The incidence of paradoxical reaction was 1.4%. In multivariate analyses, male gender, unsuccessful sedation in previous endoscopy, upper endoscopy, higher dose of midazolam, and lower dose of pethidine were identified as independent risk factors for paradoxical reaction. Despite paradoxical reaction, endoscopic procedures were successfully completed in 93.3% of cases when flumazenil was administered. The rates of meeting quality indicator of endoscopy were 92.3% in patients receiving flumazenil for paradoxical reaction and 97.6% in patients without paradoxical reaction. Conclusions: For patients with risk factors for paradoxical reaction, active use of pethidine with a dose reduction of midazolam might be helpful to prevent the occurrence of paradoxical reaction. Administration of flumazenil might be positively considered in cases of paradoxical reaction.
AB - Background: The incidence, risk factors and management strategy of paradoxical reaction to midazolam during endoscopy are yet to be clarified. Methods: This single center prospective study included 4140 adult patients (2263 males, mean age of 57.7 ± 12.6) undergoing endoscopy under sedation with midazolam and pethidine between September 2011 and December 2011. The characteristics of patients with and without paradoxical reaction were compared. For patients who experienced paradoxical reaction and received flumazenil, their endoscopic images were reviewed to assess whether European Society of Gastrointestinal Endoscopy guidelines were met as quality indicator of endoscopy. Results: The incidence of paradoxical reaction was 1.4%. In multivariate analyses, male gender, unsuccessful sedation in previous endoscopy, upper endoscopy, higher dose of midazolam, and lower dose of pethidine were identified as independent risk factors for paradoxical reaction. Despite paradoxical reaction, endoscopic procedures were successfully completed in 93.3% of cases when flumazenil was administered. The rates of meeting quality indicator of endoscopy were 92.3% in patients receiving flumazenil for paradoxical reaction and 97.6% in patients without paradoxical reaction. Conclusions: For patients with risk factors for paradoxical reaction, active use of pethidine with a dose reduction of midazolam might be helpful to prevent the occurrence of paradoxical reaction. Administration of flumazenil might be positively considered in cases of paradoxical reaction.
KW - Endoscopy
KW - Flumazenil
KW - Midazolam
KW - Paradoxical reaction
UR - http://www.scopus.com/inward/record.url?scp=84904736300&partnerID=8YFLogxK
U2 - 10.1016/j.dld.2014.04.007
DO - 10.1016/j.dld.2014.04.007
M3 - Article
C2 - 24893689
AN - SCOPUS:84904736300
SN - 1590-8658
VL - 46
SP - 710
EP - 715
JO - Digestive and Liver Disease
JF - Digestive and Liver Disease
IS - 8
ER -