Intravenous 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

Abstract

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.

Key words

Midazolam (dormicum®) - pediatric endoscopy - conscious sedation - upper endoscopy