A comparison of midazolam and diazepam for conscious sedation during colonoscopy in a prospective double-blind study
A comparison of midazolam and diazepam for conscious sedation during colonoscopy in a prospective double-blind study
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DOI：
10.1016/s0016-5107(99)70282-8
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发表时间：
1999-06-01
影响因子：
7.7
通讯作者：
Gross, JB
中科院分区：
文献类型：
--
作者：
Zakko, SF;Seifert, HA;Gross, JB
背景：咪达唑仑和地西泮常用于清醒镇静，但其相对呼吸抑制作用尚未得到准确研究。我们使用新型实时在线计算机数据采集系统在随机双盲研究中比较这两种药物。方法：对 100 名接受结肠镜检查的患者进行了研究。计算机每分钟记录最大呼气末二氧化碳张力（PetCO(2)）和脉搏血氧饱和度最小氧饱和度（SpO(2)）。患者接受哌替啶（25 至 50 毫克）和增量剂量的咪达唑仑或地西泮治疗，达到相同的言语不清和/或上睑下垂的终点。镇静评分从 1（无法唤醒）到 5（完全清醒）。结果：使用每种药物后镇静评分为 3.6 +/- 0.1（平均值 +/- 标准误差）。咪达唑仑和地西泮的剂量分别为0.031+/-0.002和0.106+/-0.009mg/kg。在前 45 分钟内，咪达唑仑组 (PetCO2) 显着高于地西泮组 (p < 0.05)。使用每种药物后，SpO(2) 显着降低 80 分钟，并且两种药物之间最低 SpO(2) 低于 90% 时的分钟数没有差异。结论：咪达唑仑的效力是地西泮的 3.4 倍。氧饱和度下降的持续时间强调了监测 SpO(2) 直至通气和氧合恢复的重要性。尽管低氧血症的程度相当，但咪达唑仑导致呼气末二氧化碳浓度较高。
Background: Midazolam and diazepam are commonly used for conscious sedation, but their comparative respiratory depressive effects have not been accurately studied. We used a novel real-time, on-line, computerized data acquisition system to compare the two agents in a randomized double-blind study.Methods: One hundred patients undergoing colonoscopy were studied. The maximum end-tidal carbon dioxide tension (PetCO(2)) and the minimum oxygen saturation by pulse oximetry (SpO(2)) were recorded by computer every minute. patients received meperidine (25 to 50 mg) and incremental doses of either midazolam or diazepam to an identical end point of slurred speech and/or ptosis. Sedation was scored from 1 (unarousable) to 5 (wide awake).Results: Sedation scores were 3.6 +/- 0.1 (mean +/- standard error) after each agent. The doses of midazolam and diazepam were 0.031 +/- 0.002 and 0.106 +/- 0.009 mg/kg, respectively. In the first 45 minutes (PetCO2) was significantly higher with midazolam than with diazepam (p < 0.05). SpO(2) was significantly depressed for 80 minutes after each agent, and the number of minutes when the minimum SpO(2) was less than 90% did not differ between the two agents.Conclusions: Midazolam was 3.4 times more potent than diazepam. The duration of oxygen desaturation emphasizes the importance of monitoring SpO(2) until ventilation and oxygenation have recovered. Although the degree of hypoxemia was comparable, midazolam led to higher end-tidal carbon dioxide tensions.