Introduction Endoscopy remains important diagnostic tools for evaluating disease, early detection of malignant lesions and the delivery of therapy within the gastrointestinal (GI) tract. There are a number of regimens that are utilised for the administration of intra-venous sedation, including benzodiazepines (BDZ). However, sedation for endoscopy is not without its risks with an influential report suggesting that many major complications arise from patients being over-sedated (1). Thus, factors that are utilised to reduce the amount of sedation, without a detrimental effect on intra-procedural comfort, are important. Thus the aim of our study was to assess the impact of a change in syringe size of BDZ offered to endoscopists on the amount of BDZ administered in sedated GI endoscopy.
Methods A 2 centre, prospective trial comparing BDZ use across all forms of sedated endoscopy across two time periods. In the first period (1st November 2010- 31st October 2011) endoscopists were given a single 5 ml syringe containing 5 mg midazolam. In the second time period (1st November 2011- 31st October 2012) endoscopists were given two 2.5 ml syringes each containing 2.5 mg midazolam. BDZ use, comfort scores and complications were compared across the two time periods. Patients who had a general anaesthetic, and those who did not have sedation, of their endoscopy were excluded.
Results Table 1 details the results. Significantly less BDZ was administered in the second time period without an impact on comfort scores. Complications related to sedation were not different.
Conclusion Offering endoscopists smaller syringes reduces BDZ use but not at the expense of comfort levels. Further longitudinal study is required to further evaluate whether reduced BDZ usage has an impact on complications.
Disclosure of Interest None Declared
Scoping Our Practice, The 2004 National Confidential Enquiry into Patient Outcomes and Death (NCEPOD), London, UK.
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