J Med Assoc Thai 2017; 100 (9):195

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Success Rate of Sedation in Esophagogastroduodenoscopy using Fentanyl and Midazolam in Combination with Topical Lidocaine
Muangman S Mail, Amornyotin S , Mangmeesri P , Chumpathong S , Pausawasdi N , Chotiwaputta W , Limsrivilai J , Svastdi-xuto O , Jaiyen T , Luansritisakul C

Objective: To evaluate the success rate of moderate sedation with fentanyl and midazolam combined with topical lidocaine in esophagogastroduodenoscopy (EGD), relative to level of patients and endoscopists’ satisfaction, time to recovery, and associated complications.
Material and Method: Patients undergoing EGD were given topical lidocaine at the pharyngeal area and intravenous sedation with a combination of fentanyl 1 mcg/kg and midazolam 20 mcg/kg. In patients who could not tolerate EGD, an additional dose of fentanyl 0.5 mcg/kg and midazolam 10 mcg/kg was administered. Patients who continued to demonstrate intolerance to EGD were given a bolus dose of propofol 1 mg/kg, followed by propofol infusion 2 to 5 mg/kg/hr. Success was defined as completion of EGD procedure using fentanyl and midazolam sedation only, with no observation of patient intolerance. After the procedure, patients and endoscopists’ satisfaction was evaluated.
Results: Eighty-two patients were enrolled in this study. Success rate of the studied sedation protocol was 100%, but two patients required an additional dose of fentanyl and midazolam. Seventy-six participants (92.7%) were satisfied with the sedation technique, and 100% of endoscopists reported being either satisfied or very satisfied. The average time to following verbal commands after completion of the procedure was 1.4 minutes. Desaturation was observed in one patient, which was corrected by jaw-thrust maneuver and increased oxygen flow.
Conclusion: Intravenous fentanyl and midazolam combined with topical lidocaine in EGD yielded good results and a high level of satisfaction among both patients and endoscopists with some acceptable complications.

Keywords:
Esophagogastroduodenoscopy, Intravenous sedation, success rate, Fentanyl, midazolam, Topical lidocaine


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