Midazolam dose is associated with recurrence of paradoxical reactions during endoscopy  

作　　者：Eun Hyo Jin Ji Hyun Song Jooyoung Lee Jung Ho Bae Su Jin Chung 

机构地区：[1]Department of Internal Medicine,Healthcare Research Institute,Healthcare System Gangnam Center,Seoul National University Hospital,Seoul 06236,South Korea

出　　处：《World Journal of Clinical Cases》2021年第29期8763-8772,共10页世界临床病例杂志

摘　　要：BACKGROUND Midazolam is commonly used for sedation during gastrointestinal procedures.However,some patients experience paradoxical reactions characterized by excessive movement or excitement.AIM To investigate the rate of recurrence of paradoxical reactions to midazolam during an upper endoscopy.METHODS We retrospectively reviewed 122152 sedative endoscopies among a total of 58553 patients at the Seoul National University Hospital,Healthcare System Gangnam Center,from July 2013 to December 2018.Among them,361 patients with a history of paradoxical reaction during sedative upper endoscopy were enrolled.The characteristics of patients in the recurrent and non-recurrent groups were compared via multivariable analysis using logistic regression.RESULTS Paradoxical reactions occurred in 0.86%(1054/122152)of endoscopies,and in 1.51%(888/58553)of patients.Among the 361 subjects with previous paradoxical reactions in sedative endoscopies,111(30.7%)experienced further paradoxical reactions.Univariable analysis revealed that the total midazolam dose used was higher in the recurrent group(6.74±2.58 mg)than in the non-recurrent group(5.49±2.04 mg;P<0.0001).Patients were administered a lower dose of midazolam than previous doses:1 mg less in the recurrent group and 2 mg less in the non-recurrent group.Multivariable analysis showed that the midazolam dose difference was an independent risk factor for recurrent paradoxical reaction(odds ratio:1.213,95%CI:1.099-1.338,P=0.0001).CONCLUSION The rate of recurrence of paradoxical reactions is significantly associated with midazolam dosage.The dose of midazolam administered to patients with previous paradoxical reactions should be less than that previously used.

关 键 词：GASTROSCOPY ENDOSCOPY Conscious sedation MIDAZOLAM FLUMAZENIL 

分 类 号：R969.3[医药卫生—药理学]