Predictable Factors for Paradoxical Reactions in Conscious Sedation with Midazolam During ERCP.
- Author:
Young Jin SEO
1
;
Ho Gak KIM
;
Jong Seok BAE
;
Juhn Yeob LEE
;
Moo Gon KIM
;
Kyung Jin LIM
;
Sang Hyeok LIM
;
Byung Ryul CHOI
;
Eun Young KIM
;
Joong Goo KWEON
;
Chang Hyeong LEE
;
Jung Dong BAE
;
Ju Young LEE
Author Information
1. Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea. ghkim@cataegu.ac.kr
- Publication Type:Original Article
- Keywords:
Endoscopic retrograde cholagiopancreaticography;
Midazolam;
Conscious sedation;
Paradoxical reaction
- MeSH:
Cholangiopancreatography, Endoscopic Retrograde*;
Conscious Sedation*;
Dihydroergotamine;
Flumazenil;
Humans;
Meperidine;
Midazolam*;
Multivariate Analysis;
Risk Factors
- From:Korean Journal of Gastrointestinal Endoscopy
2001;23(6):451-460
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND/AIMS: Paradoxical reaction after midazolam administration is relatively uncommon and can obstruct the performance of ERCP. But it can not be predicted before drug administration. We investigate the difference in occurrence of paradoxical reaction according to personal characteristics and clinical status of patients. METHODS: During 155 ERCP procedures, we injected midazolam and meperidine intravenously for conscious sedation until deep sleep occurred. Among 155 patients, 108 patients did not showed paradoxical reaction (group I) and 47 patients (30.3%) showed gross behavioral disturbance and/or agitation (group II). Paradoxical agitation was seen in 9 (7.1%) procedures. RESULTS: Type A-like personality (p=0.002), sleep-talking habit (p=0.026) and presence of pain at the beginning of ERCP (p=0.036) and during ERCP (p=0.021) were seen more frequently in group II. Duration of ERCP was longer (p=0.034) and dosage of midazolam was larger (p=0.009) in group II. In multivariate analysis, having sleep-talking (OR, 5.5), type A-like personality (OR 3.9) and dosage of midazolam (OR 1.3) were risk factors of paradoxical reaction. CONCLUSIONS: Paradoxical agitation after midazolam administration was uncommon and can be managed with flumazenil. Paradoxical reaction can be predicted more often in patients with type A-like personality, sleep-talking habit, complaining pain before ERCP, and in patients injected large dosage of midazolam.
