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Administration of additional analgesics can decrease the incidence of paradoxical reactions in patients under benzodiazepine‐induced sedation during endoscopic transpapillary procedures: Prospective randomized controlled trial
Author(s) -
Terui Torahiko,
Inomata Masaaki
Publication year - 2013
Publication title -
digestive endoscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.5
H-Index - 56
eISSN - 1443-1661
pISSN - 0915-5635
DOI - 10.1111/j.1443-1661.2012.01325.x
Subject(s) - midazolam , medicine , sedation , anesthesia , incidence (geometry) , pentazocine , benzodiazepine , odds ratio , propofol , analgesic , randomized controlled trial , prospective cohort study , endoscopic retrograde cholangiopancreatography , surgery , physics , receptor , pancreatitis , optics
Aim The aim of the present study was to evaluate the efficacy and safety of giving pentazocine as an analgesic with benzodiazepine during endoscopic retrograde cholangiopancreatography ( ERCP ). Methods The paradoxical reactions ( PR ) incidence was evaluated as an indicator of usefulness. Transcutaneous arterial carbon dioxide tension ( PtcCO 2 ) was evaluated as an indicator of safety. Atotal of 160 patients were enrolled. Subjects were randomly divided into two groups; group 1 sedated with midazolam only and group 2 sedated both with midazolam and pentazocine (7.5 mg ). Results The initial dosage introduced sedation before procedure was significantly higher in group 1. The occurrence rate of PR's in group 1 was significantly higher compared to that in group2 ( P = 0.0108). Although maximum PtcCO 2 observed during sedation did not differ between the two groups (48.7 ± 7.2, 50.3 ± 7.6 mmHg , respectively),maximum PtcCO 2 during the first 15 min after the start of sedation was significantly higher in group 2 than in group 1 ( P = 0.0294). In multivariate analysis, procedure duration (odds ratio [ OR ] = 1.048) and midazolam dose ( OR = 1.221) were predictive factors for PR . Conclusion The administration of pentazocine is significantly reduced the incidence of PR's in patients under midazolaminduced sedation during ERCP .