Midazolam Sedation in Pediatric Diagnostic Upper Digestive Endoscopy
(n=257). A Prospective Study in a General Hospital
Jan Verhage1, Chris
J.J. Mulder2, Frans L.A. Willekens3
1) Department of Pediatrics,
2) Gastroenterology, 3) Clinical Chemistry, Rijnstate Hospital,
Arnhem, The Netherlands
The positive role of benzodiazepines
(Midazolam) in conscious sedation in pediatric patients is widely
known. However, problems concerning the role of sedation in
diagnostic upper endoscopy are a matter for debate as little
is known about dosage and timing.
We prospectively evaluated
the efficacy, safety and optimal intravenous sedation dosage
of midazolam in 257 consecutive patients, aged 2 months to 18
years old, who underwent upper endoscopy of the gastrointestinal
tract. The initial midazolam dosage was 0.2 mg/kg Bw (Body weight)
i.v. for 1 minute and, if necessary, another 0.1 mg/kg Bw was
administered 5 minutes later. If sedation was sufficient, the
procedure would be started 4-5 minutes later; if not, another
0.1 – 0.2 mg/kg Bw would be administered. All procedures
were performed by a pediatrician together with a gastroenterologist.
No serious complications
occurred in any of the procedures. Oxygen saturation (OS) was
maintained at over 90%, if necessary with blowby oxygen. Flumazenil
was administered to 7 children (OS <90%). Endoscopy could
not be completed in 1 child. All endoscopies were completed
within 10 minutes. No unexpected hospital admissions were necessary.
The mean midazolam dosage was 0.4 mg/kg Bw in patients up to
6 years, for the over 6 years-olds the mean dosage was decreased
to 0,2 mg/kg Bw. Particular attention was paid to the importance
of informing patients before the procedure.
Endoscopic diagnostic procedures
can be performed safely and effectively in children with intravenous
sedation in a well equipped pediatric endoscopy unit.
- pediatric endoscopy - conscious sedation - upper endoscopy