Sedation for Endoscopic Ultrasonography: Propofol with Low-Dose Midazolam Versus Midazolam

Abstract

Background and Aims: Benzodiazepines are commonly used for sedation for EUS. Recently some clinical studies have shown that propofol is effective and safety for sedation of patients EUS. This study was carried out to determine the usefulness and safety of propofol combined with low-dose midazolam for sedation in EUS. Patients and Methods: Seventy-seven patients who were scheduled to undergo EUS were enrolled this study, and randomly divided into a group to be sedated by midazolam (M group, n = 40) and a group by propofol and low-dose midazoram (P group, n = 37). M group: Midazolam (4 mg) was administered by intravenous injection at the start of the EUS, and further IV injections of midazolam (each 2 mg) were given as directed by the operator if necessary. P group: Midazolam (2 mg) and propofol (10 mg) were given by IV injection at the start of the EUS, and further IV injections of propofol (each 10 mg) were given. Patients with body weight of 50 kg or less or aged 80 years or older were given half doses. After recovery, each patient was instructed to fill out a questionnaire on discomfort during the EUS and degree of satisfaction regarding sedation using the visual analog scale (VAS; 0.0 (good) - 10.0 (bad)). The operator and assistant evaluated each patient's cooperation and tolerance by the VAS. The groups divided by Alcohol Index, into heavy alcohol group (HA group) and low alcohol group (LA group). Result: No serious complication occurred in either group. The average amount of midazolam used in the M group was 7.1 ± 2.6 mg (C.I. 95%), and the average amounts of midazolam and propofol used in the P group were 1.8 ± 0.4 mg and 54.9 ± 25.9 mg. There was no difference between the two groups in the time of EUS (M: 32.4 ± 4.8 min, P: 28.8 ± 4.1 min, p = 0.251), but the time of recovery in the P group was shorter than that in the M group (59.8 ± 29.0, 24.2 ± 20.7, p < 0.001). There was no difference between the two groups in patients' discomfort or satisfaction. According to assessment by the operators and the assistants, the P group were more cooperative than the M group (p = 0.003, p = 0.001) and the P group had greater tolerance than the M group (p < 0.001, p = 0.001). In the M group, the operators and the assistants had tendency to evaluate lower the cooperation and the tolerance in the HA group than in the LA group (p = 0.061, p = 0.077), but in the P group, there was no difference of the evaluation between the HA group and LA group (p = 0.315, 0.319). Conclution: Propofol with low-dose midazolam is safe and effective for sedation of patients, and the effectiveness has not changed by the amount of drinking alcohol. The quick recovery of patients is beneficial for both the patient and the hospital.