Clin Endosc.  2013 Jul;46(4):368-372.

Propofol versus Midazolam for Sedation during Esophagogastroduodenoscopy in Children

• Oh JE
• Lee HJ
• Lee YH

Abstract

BACKGROUND/AIMS
To evaluate the efficacy and safety of propofol and midazolam for sedation during esophagogastroduodenoscopy (EGD) in children.
METHODS
We retrospectively reviewed the hospital records of 62 children who underwent ambulatory diagnostic EGD during 1-year period. Data were collected from 34 consecutive patients receiving propofol alone. Twenty-eight consecutive patients who received sedation with midazolam served as a comparison group. Outcome variables were length of procedure, time to recovery and need for additional supportive measures.
RESULTS
There were no statistically significant differences between the two groups in age, weight, sex, and the length of endoscopic procedure. The recovery time from sedation was markedly shorter in propofol group (30+/-16.41 minutes) compared with midazolam group (58.89+/-17.32 minutes; p<0.0001). During and after the procedure the mean heart rate was increased in midazolam group (133.04+/-19.92 and 97.82+/-16.7) compared with propofol group (110.26+/-20.14 and 83.26+/-12.33; p<0.0001). There was no localized pain during sedative administration in midazolam group, though six patients had localized pain during administration of propofol (p<0.028). There was no serious major complication associated with any of the 62 procedures.
CONCLUSIONS
Intravenous administered propofol provides faster recovery time and similarly safe sedation compared with midazolam in pediatric patients undergoing upper gastrointestinal endoscopy.

Keyword

Propofol; Midazolam; Endoscopy, digestive system; Child

MeSH Terms

Child
Endoscopy, Digestive System
Endoscopy, Gastrointestinal
Heart Rate
Hospital Records
Humans
Midazolam
Propofol
Retrospective Studies
Midazolam
Propofol

Reference

1. Hertzog JH, Campbell JK, Dalton HJ, Hauser GJ. Propofol anesthesia for invasive procedures in ambulatory and hospitalized children: experience in the pediatric intensive care unit. Pediatrics. 1999; 103:E30. PMID: 10049986.

2. Squires RH Jr, Morriss F, Schluterman S, Drews B, Galyen L, Brown KO. Efficacy, safety, and cost of intravenous sedation versus general anesthesia in children undergoing endoscopic procedures. Gastrointest Endosc. 1995; 41:99–104. PMID: 7721025.

3. Lightdale JR, Valim C, Newburg AR, Mahoney LB, Zgleszewski S, Fox VL. Efficiency of propofol versus midazolam and fentanyl sedation at a pediatric teaching hospital: a prospective study. Gastrointest Endosc. 2008; 67:1067–1075. PMID: 18367187.

4. Abu-Shahwan I, Mack D. Propofol and remifentanil for deep sedation in children undergoing gastrointestinal endoscopy. Paediatr Anaesth. 2007; 17:460–463. PMID: 17474953.

5. Oei-Lim VL, Kalkman CJ, Bartelsman JF, Res JC, van Wezel HB. Cardiovascular responses, arterial oxygen saturation and plasma catecholamine concentration during upper gastrointestinal endoscopy using conscious sedation with midazolam or propofol. Eur J Anaesthesiol. 1998; 15:535–543. PMID: 9785067.

6. Barbi E, Petaros P, Badina L, et al. Deep sedation with propofol for upper gastrointestinal endoscopy in children, administered by specially trained pediatricians: a prospective case series with emphasis on side effects. Endoscopy. 2006; 38:368–375. PMID: 16680636.

7. Morse JW, Fowler SA, Morse AL. Endoscopist-administered propofol: a retrospective safety study. Can J Gastroenterol. 2008; 22:617–620. PMID: 18629390.

8. Cohen LB, Dubovsky AN, Aisenberg J, Miller KM. Propofol for endoscopic sedation: a protocol for safe and effective administration by the gastroenterologist. Gastrointest Endosc. 2003; 58:725–732. PMID: 14595310.

9. American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002; 96:1004–1017. PMID: 11964611.

10. van Beek EJ, Leroy PL. Safe and effective procedural sedation for gastrointestinal endoscopy in children. J Pediatr Gastroenterol Nutr. 2012; 54:171–185. PMID: 21975965.

11. Elitsur Y, Blankenship P, Lawrence Z. Propofol sedation for endoscopic procedures in children. Endoscopy. 2000; 32:788–791. PMID: 11068839.

12. Disma N, Astuto M, Rizzo G, et al. Propofol sedation with fentanyl or midazolam during oesophagogastroduodenoscopy in children. Eur J Anaesthesiol. 2005; 22:848–852. PMID: 16225720.

13. Fredette ME, Lightdale JR. Endoscopic sedation in pediatric practice. Gastrointest Endosc Clin N Am. 2008; 18:739–751. PMID: 18922412.

14. von Delius S, Hollweck R, Schmid RM, Frimberger E. Midazolam-pain, but one cannot remember it: a survey among Southern German endoscopists. Eur J Gastroenterol Hepatol. 2007; 19:465–470. PMID: 17489056.

15. Lamireau T, Dubreuil M, Daconceicao M. Oxygen saturation during esophagogastroduodenoscopy in children: general anesthesia versus intravenous sedation. J Pediatr Gastroenterol Nutr. 1998; 27:172–175. PMID: 9702648.

16. Lazzaroni M, Bianchi Porro G. Preparation, premedication and surveillance. Endoscopy. 2003; 35:103–111. PMID: 12561003.

17. Rex DK, Deenadayalu VP, Eid E, et al. Endoscopist-directed administration of propofol: a worldwide safety experience. Gastroenterology. 2009; 137:1229–1237. PMID: 19549528.

18. Cravero JP, Beach ML, Blike GT, Gallagher SM, Hertzog JH. Pediatric Sedation Research Consortium. The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium. Anesth Analg. 2009; 108:795–804. PMID: 19224786.

19. Khoshoo V, Thoppil D, Landry L, Brown S, Ross G. Propofol versus midazolam plus meperidine for sedation during ambulatory esophagogastroduodenoscopy. J Pediatr Gastroenterol Nutr. 2003; 37:146–149. PMID: 12883300.

20. Mencía SB, López-Herce JC, Freddi N. Analgesia and sedation in children: practical approach for the most frequent situations. J Pediatr (Rio J). 2007; 83(2 Suppl):S71–S82. PMID: 17530139.

21. 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; 43:195–199. PMID: 16877984.

22. Jalota L, Kalira V, George E, et al. Prevention of pain on injection of propofol: systematic review and meta-analysis. BMJ. 2011; 342:d1110. PMID: 21406529.