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Synergistic sedation with oral midazolam as a premedication and intravenous propofol versus intravenous propofol alone in upper gastrointestinal endoscopies in children: a prospective, randomized study.
J Pediatr Gastroenterol Nutr. 2006 Aug; 43(2):195-9.JP

Abstract

OBJECTIVES

The primary objective of the present study was to compare the required dose of intravenous (IV) propofol between group A (synergistic sedation with an oral dose of midazolam combined with IV propofol) and group B (IV propofol alone), in diagnostic upper gastrointestinal endoscopy (UGIE) in pediatric patients. The secondary objective was to compare the safety, the efficacy, the ease of IV line placement and the ease of separation from parents between the 2 groups.

METHODS

Fifty-four consecutive children (aged 3 y or older) who underwent UGIE were randomly assigned to 1 of the 2 medication regimens. Patients in group A (n = 26, mean age: 8.1 y) received midazolam (0.5 mg/kg) orally. Thirty minutes after the midazolam dose was given, repeated IV doses of propofol 0.5 mg/kg were administered titrated to achieve the level of deep sedation. Patients in group B (n = 28, mean age: 9 y) received IV propofol alone with the same methodology and sedation end point.

RESULTS

The mean dose (1.8 +/- 0.7 mg/kg) of propofol administered in group A patients was remarkably lower compared with that (2.9 +/- 0.9 mg/kg) of group B. Multivariate stepwise logistic regression analysis revealed that among sex, age, ASA grade and the type of sedation, the synergistic sedation was the only factor associated with the ease of IV line placement (chi(2) = 16.3, P < 0.001) and the ease of separation from parents (chi(2) = 41.6, P < 0.001). Additional multivariate stepwise logistic regression analysis revealed that among sex, age, ASA grade and the type of sedation, synergistic sedation was the only factor associated with a higher level of patient comfort (chi(2) = 35.5, P < 0.001). The recovery time was significantly shorter in group B patients (7.7 +/- 3.6 min) compared with that of group A (25.9 +/- 4.1 minutes) (P < 0.01). The 2 regimens were equally safe.

CONCLUSIONS

Our data suggest that synergistic sedation with an oral dose of midazolam combined with propofol may benefit the children who undergo UGIE with regard to lower mean dose of propofol used, easier IV line placement, easier separation from the parents, less pain induced by the IV line placement and greater patient comfort.

Authors+Show Affiliations

Department of Gastroenterology, Benizelion General Hospital, Heraklion, Crete, Greece. paspati@admin.teiher.grNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

16877984

Citation

Paspatis, Gregorios A., et al. "Synergistic Sedation With Oral Midazolam as a Premedication and Intravenous Propofol Versus Intravenous Propofol Alone in Upper Gastrointestinal Endoscopies in Children: a Prospective, Randomized Study." Journal of Pediatric Gastroenterology and Nutrition, vol. 43, no. 2, 2006, pp. 195-9.
Paspatis GA, Charoniti I, Manolaraki M, et al. Synergistic sedation with oral midazolam as a premedication and intravenous propofol versus intravenous propofol alone in upper gastrointestinal endoscopies in children: a prospective, randomized study. J Pediatr Gastroenterol Nutr. 2006;43(2):195-9.
Paspatis, G. A., Charoniti, I., Manolaraki, M., Vardas, E., Papanikolaou, N., Anastasiadou, A., & Gritzali, A. (2006). Synergistic sedation with oral midazolam as a premedication and intravenous propofol versus intravenous propofol alone in upper gastrointestinal endoscopies in children: a prospective, randomized study. Journal of Pediatric Gastroenterology and Nutrition, 43(2), 195-9.
Paspatis GA, et al. Synergistic Sedation With Oral Midazolam as a Premedication and Intravenous Propofol Versus Intravenous Propofol Alone in Upper Gastrointestinal Endoscopies in Children: a Prospective, Randomized Study. J Pediatr Gastroenterol Nutr. 2006;43(2):195-9. PubMed PMID: 16877984.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Synergistic sedation with oral midazolam as a premedication and intravenous propofol versus intravenous propofol alone in upper gastrointestinal endoscopies in children: a prospective, randomized study. AU - Paspatis,Gregorios A, AU - Charoniti,Ioanna, AU - Manolaraki,Maria, AU - Vardas,Emmanouil, AU - Papanikolaou,Nikolaos, AU - Anastasiadou,Almout, AU - Gritzali,Aliki, PY - 2006/8/1/pubmed PY - 2006/10/17/medline PY - 2006/8/1/entrez SP - 195 EP - 9 JF - Journal of pediatric gastroenterology and nutrition JO - J Pediatr Gastroenterol Nutr VL - 43 IS - 2 N2 - OBJECTIVES: The primary objective of the present study was to compare the required dose of intravenous (IV) propofol between group A (synergistic sedation with an oral dose of midazolam combined with IV propofol) and group B (IV propofol alone), in diagnostic upper gastrointestinal endoscopy (UGIE) in pediatric patients. The secondary objective was to compare the safety, the efficacy, the ease of IV line placement and the ease of separation from parents between the 2 groups. METHODS: Fifty-four consecutive children (aged 3 y or older) who underwent UGIE were randomly assigned to 1 of the 2 medication regimens. Patients in group A (n = 26, mean age: 8.1 y) received midazolam (0.5 mg/kg) orally. Thirty minutes after the midazolam dose was given, repeated IV doses of propofol 0.5 mg/kg were administered titrated to achieve the level of deep sedation. Patients in group B (n = 28, mean age: 9 y) received IV propofol alone with the same methodology and sedation end point. RESULTS: The mean dose (1.8 +/- 0.7 mg/kg) of propofol administered in group A patients was remarkably lower compared with that (2.9 +/- 0.9 mg/kg) of group B. Multivariate stepwise logistic regression analysis revealed that among sex, age, ASA grade and the type of sedation, the synergistic sedation was the only factor associated with the ease of IV line placement (chi(2) = 16.3, P < 0.001) and the ease of separation from parents (chi(2) = 41.6, P < 0.001). Additional multivariate stepwise logistic regression analysis revealed that among sex, age, ASA grade and the type of sedation, synergistic sedation was the only factor associated with a higher level of patient comfort (chi(2) = 35.5, P < 0.001). The recovery time was significantly shorter in group B patients (7.7 +/- 3.6 min) compared with that of group A (25.9 +/- 4.1 minutes) (P < 0.01). The 2 regimens were equally safe. CONCLUSIONS: Our data suggest that synergistic sedation with an oral dose of midazolam combined with propofol may benefit the children who undergo UGIE with regard to lower mean dose of propofol used, easier IV line placement, easier separation from the parents, less pain induced by the IV line placement and greater patient comfort. SN - 0277-2116 UR - https://www.unboundmedicine.com/medline/citation/16877984/Synergistic_sedation_with_oral_midazolam_as_a_premedication_and_intravenous_propofol_versus_intravenous_propofol_alone_in_upper_gastrointestinal_endoscopies_in_children:_a_prospective_randomized_study_ L2 - https://doi.org/10.1097/01.mpg.0000228099.04702.39 DB - PRIME DP - Unbound Medicine ER -