Clin Endosc.  2022 Mar;55(2):234-239. 10.5946/ce.2021.126.

Propofol Alone versus Propofol in Combination with Midazolam for Sedative Endoscopy in Patients with Paradoxical Reactions to Midazolam

• Nam JH
• Jang DK
• Lee JK
• Kang HW
• Kim BW
• Jang BI
• the Committees of Quality Management and Conscious Sedation of Korean Society of Gastrointestinal Endoscopy (KSGE)

• KMID: 2527567
• DOI: http://doi.org/10.5946/ce.2021.126

Abstract

Background/Aims
The efficacy of propofol in gastrointestinal endoscopy for patients with midazolam-induced paradoxical reactions remains unclarified. This study aimed to compare the efficacy and safety of propofol-based sedation in patients who previously experienced paradoxical reactions.
Methods
This was a prospective, single-blinded, randomized controlled pilot study. Participants with a history of paradoxical reactions to midazolam during a previous esophagogastroduodenoscopy were recruited and randomly assigned to group I (propofol monosedation) or group II (combination of propofol and midazolam). The primary endpoint was the occurrence of a paradoxical reaction.
Results
A total of 30 participants (mean age, 54.7±12.6 years; male, 19/30) were randomly assigned to group I (n=16) or group II (n=14). There were no paradoxical reactions in group I, but there were two in group II, without a significant difference (p=0.209). The mean dose of propofol was higher in group I than in group II (p=0.002). Meanwhile, the procedure and recovery times did not differ between groups.
Conclusions
Propofol-based sedation was safe and effective for patients who experienced paradoxical reactions to midazolam. However, caution is needed because few cases of paradoxical reaction again can happen in group II in which midazolam was readministered.

Keyword

Endoscopy; Midazolam; Paradoxical reaction; Propofol; Sedation