Safety of midazolam for sedation of HIV-positive patients undergoing colonoscopy.
Safety of midazolam for sedation of HIV-positive patients undergoing colonoscopy.
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DOI：
10.1111/hiv.12014
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发表时间：
2013-07
期刊：
影响因子：
3
通讯作者：
Gandhi RT
中科院分区：
文献类型：
--
作者：
Backman ES;Triant VA;Ehrenfeld JM;Lu Z;Arpino P;Losina E;Gandhi RT
对咪达唑仑和抗逆转录病毒药物之间可能相互作用的担忧导致临床医生使用二线镇静剂，如地西泮。我们证明了在结肠镜检查期间接受咪达唑仑的患者与接受地西泮的患者具有相似的临床结局。由于对咪达唑仑和抗逆转录病毒治疗（ART）之间相互作用的担忧，有时在手术镇静期间使用替代镇静剂。我们的目的是比较在结肠镜检查期间接受静脉注射（IV）咪达唑仑与静脉注射地西泮（二线药物）的ART患者的结局。我们对接受结肠镜检查超过3.5年的成人HIV感染患者进行了回顾性分析。主要结果为镇静持续时间、最低收缩压、最低血氧饱和度、异常心律和使用标准化量表的意识水平变化。我们根据苯二氮卓类药物的使用情况计算了不良事件的发生率，并使用单变量和多变量分析确定了并发症的危险因素。我们确定了136例患者进行分析：70例接受咪达唑仑为基础的镇静，66例接受地西泮为基础的方案。两组在镇静持续时间方面无显著差异（48 vs 45.7分钟，P = 0.68），最低收缩压（97 vs 101.6 mmHg，P = 0.06），最低血氧饱和度（94.6对94.8%，P = 0.72）或心律异常率（11.4对19.7%，P = 0.18）。咪达唑仑组中更多的患者出现意识水平降低（91% vs 74%，P = 0.0075），但没有患者需要逆转镇静或变得无反应。虽然IV咪达唑仑与ART相互作用，但我们没有发现证据表明接受该药物用于手术镇静的患者与接受地西泮的患者的临床结局存在统计学差异。这些发现应该在前瞻性研究或随机对照试验中得到证实。
Concerns regarding possible interactions between midazolam and antiretroviral medicines have caused clinicians to use second-line sedatives, such as diazepam, instead. We demonstrated that patients who received midazolam during colonoscopy had similar clinical outcomes as those who received diazepam. Because of concerns regarding interactions between midazolam and antiretroviral therapy (ART), alternative sedatives are sometimes used during procedural sedation. Our objective was to compare outcomes in patients on ART who received intravenous (IV) midazolam versus IV diazepam, a second-line agent, during colonoscopy. We conducted a retrospective analysis of adult HIV-infected patients who underwent colonoscopy over a 3.5-year period. Primary outcomes were sedation duration, nadir systolic blood pressure, nadir oxygen saturation, abnormal cardiac rhythm, and change in level of consciousness using a standardized scale. We calculated rates of adverse events according to benzodiazepine use and identified risk factors for complications using univariate and multivariate analyses. We identified 136 patients for this analysis: 70 received midazolam-based sedation and 66 received a diazepam-based regimen. There were no significant differences between the two groups with respect to sedation duration (48 versus 45.7 minutes, P = 0.68), nadir systolic blood pressure (97 versus 101.6 mmHg, P = 0.06), nadir oxygen saturation (94.6 versus 94.8%, P = 0.72), or rate of abnormal cardiac rhythm (11.4 versus 19.7%, P = 0.18). More patients in the midazolam group experienced a depressed level of consciousness (91 versus 74%, P = 0.0075), but no patient required reversal of sedation or became unresponsive. Although IV midazolam interacts with ART, we did not find evidence that patients who received this agent for procedural sedation had clinical outcomes statistically different from those who received diazepam. These findings should be confirmed in prospective studies or in a randomized controlled trial.
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DOI：
10.1016/j.atc.2004.06.001
发表时间：
2004-09-01
期刊：
Anesthesiology clinics of North America
影响因子：
--
作者：
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通讯作者：
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