Investigative and Clinical Urology

The Korean Urological Association (대한비뇨의학회)
권호 표지

The Efficacy and Safety of Midazolam Induced Sedative Cystoscopy

Midazolam을 이용한 수면 방광경의 효용성

Jeong, Ho-Joon;Chung, Woo-Sik;Yoon, Ha-na
정호준;정우식;윤하나

  • Published : 20040600
⟨ Previous Next ⟩

Abstract

Purpose: Cystoscopy is very common and is one of the major office based procedures used in urologic clinics. However, a majority of patients complain of fear, pain, and discomfort when performing the procedure in an alert state. Routine administration of sedative and analgesic drugs is widely provided for gastorintestinal endoscopy to prevent patient discomfort and increase tolerance. Based on this, we investigated the safety and efficacy of midazolam induced sedative cystoscopy. Materials and Methods: One hundred and twenty patients were enrolled in this study. They were divided into two groups; group I (n=80) consisted of patients who were sedated by midazolam 2.5mg IV before cystoscopy, and group II (n=40) consisted of patients who were not sedated and diclopenac 90mg was injected in them intramuscularly before cystoscopy to prevent pain. All patients in group I were reversed from the sedative state by flumazenil 0.5mg IV right after the completion of the cystoscopic procedure. The two groups were not significantly different in their age, sex, and weight distribution (p>0.05). Blood pressure, pulse, and respiratory rates were monitored pre-, intra-, and post procedure. The status of consciousness was monitored every three minutes by the OAA/S (Observer's Assessment of Alertness/Sedation) scale. Pain scale, anxiety scale, satisfaction score from patients and operators were measured using a specified questionnaire. Results: In group I, the pain scale and anxiety scale were significantly reduced compared to group II (p<0.001). There were temporary changes in blood pressure and pulse rate in group I, but they were not clinically significant and no specific management was required. Group I patients were significantly more satisfied with their procedures compared to the patients of group II (p<0.001). Conclusions: Midazolam induced sedative cystoscopy can be applied safely and effectively as an outpatient base procedure. Further, we expect to apply this sedative procedure to other urologic procedures.

Keywords

References

  1. Birch B, Miller R. Safety of midazolam. Lancet 1988;2:683
  2. Reves JG, Fragen RJ, Vinik HR, Greenblatt DJ. Midazolam: pharmacology and uses. Anesthesiology 1985;62:310-24 https://doi.org/10.1097/00000542-198503000-00017
  3. Birch BR, Anson KM, Kalmanovitch DV, Cooper J, Miller RA. Sedation for day-case urology: an assessment of patient recovery profiles after midazolam and flumazenil. Ann R Coll Surg Engl 1991;73:373-8
  4. Holmes CM, Galletly DG. Midazolam/fentanyl. A total intravenous technique for short procedures. Anaesthesia 1982;37: 761-5 https://doi.org/10.1111/j.1365-2044.1982.tb01318.x
  5. Birch BR, Anson KM, Miller RA. Sedoanalgesia in urology: a safe, cost-effective alternative to general anaesthesia. A review of 1020 cases. Br J Urol 1990;66:342-50 https://doi.org/10.1111/j.1464-410X.1990.tb14952.x
  6. Bell GD. Premedication, preparation, and surveillance. Endoscopy 2002;34:2-12
  7. Hanno PM, Wein AJ. Anesthetic techniques for cystoscopy in men. J Urol 1983;130:1070-2 https://doi.org/10.1016/S0022-5347(17)51689-4
  8. Janet MV, Paul FW. Outpatient anesthesia. In: Ronald DM, editor. Anesthesia. 5th ed. Philadelphia: Churchill Livingstone; 2000;2233
  9. Ballentine CH. Basic instrumentation and cystoscopy. In: Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ, editors. Campbell's urology. 8th ed. Philadelphia: Saunders; 2002; 111-21
  10. Zuccaro G Jr. Sedation and sedationless endoscopy. Gastrointest Endosc Clin N Am 2000;10:1-20
  11. Dundee JW, Halliday NJ, Harper KW, Brogden RN. Midazolam. A review of its pharmacological properties and therapeutic use. Drugs 1984;28:519-43 https://doi.org/10.2165/00003495-198428060-00002
  12. Forster A, Gardaz JP, Suter PM, Gemperle M. Respiratory depression by midazolam and diazepam. Anesthesiology 1980; 53:494-7 https://doi.org/10.1097/00000542-198012000-00010
  13. Conner JT, Katz RL, Pagano RR, Graham CW. RO 21-3981 for intavenous surgical premedication and induction of anesthesia. Anesth Analg 1978;57:1-5
  14. Carrougher JG, Kadakia S, Shaffer RT, Barrilleaux C. Venous complications of midazolam versus diazepam. Gastrointest Endosc 1993;39:396-9 https://doi.org/10.1016/S0016-5107(93)70113-3
  15. Fragen RJ, Gahl F, Caldwell N. A water-soluble benzodiazepine, RO21-3981, for induction of anesthesia. Anesthesiology 1978;49:41-3 https://doi.org/10.1097/00000542-197807000-00012
  16. Scholer SG, Schafer DF, Potter JF. The effect of age on the relative potency of midazolam and diazepam for sedation in upper gastrointestinal endoscopy. J Clin Gastroenterol 1990; 12:145-7 https://doi.org/10.1097/00004836-199004000-00006
  17. Froehlich F, Thorens J, Schwizer W, Preisig M, Kohler M, Hays RD, et al. Sedation and analgesia for colonoscopy: patient tolerance, pain, and cardiorespiratory parameters. Gastrointest Endosc 1997;45:1-9
  18. Darragh A, Lambe R, Scully M, Brick I, O'Boyle C, Downie WW. Investigation in man of the efficacy of a benzodiazepine antagonist, RO 15-1788. Lancet 1981;2:8-10
  19. Brogden RN, Goa KL. Flumazenil: a preliminary review of its benzodiazepine antagonist properties, intrinsic activity and therapeutic use. Drugs 1988;35:448-67 https://doi.org/10.2165/00003495-198835040-00004
  20. Birch BR, Anson K, Gelister J, Parker C, Miller RA. The role of midazolam and flumazenil in urology. Acta Anaesthesiol Scand Suppl 1990;92:25-32