Gastroscopy: midazolam increased toleration of the procedure but led to more hypoxia

Clinical bottom line (level 1b)

  1. Elderly inpatients undergoing gastroscopy who received sedation using midazolam compared with placebo were more likely to tolerated the procedure well (NNT = 4 at 2 hours) .
  2. Patients who received midazolam were more likely to become hypoxic (NNH = 4 at 2 hours) , but were not clearly more likely to develop confusion.
Christe et al: J Am Geriatr Soc 2000; 48 : 1398-1403
Expires January 2004

The study

Double-blinded unconcealed randomised trial with intention-to-treat
Setting: geriatric university hospital, Switzerland

65 patients (aged 63 to 98; mean 84, 78% male) in hospital undergoing gastroscopy

Excluded if
  • mysaesthenia gravis
  • mini-mental state exam score < 20

Control Group: (n = 33, 33 analysed): sedation with placebo (saline)
Experimental Group: (n = 32, 32 analysed): sedation with midazolam 30 microgram/kg
Patients could receive a dose of midazolam if the procedure was poorly tolerated.
100% followed for 24 hours
Outcome notes:
  • hypoxia : SaO2 < 92%

The evidence

Outcome Time to outcome CER EER RRR
(95% CI)		 ARR
(95% CI)		 NNT
(95% CI)
tolerance of procedure good or very good 2 hours 22
(66.7%)		 30
(93.8%)		 41%
(9% to 82%)		 27.1%
(8.94% to 45.2%)		 4
(2 to 11)
acute confusion 2 hours 4
(12.1%)		 7
(21.9%)		 -80%
(-460% to 42%)		 -9.75%
(-27.9% to 8.39%)		 -10
(NNT = 4 to infinity;
NNH = 12 to infinity)
hypoxia 2 hours 6
(18.2%)		 14
(43.8%)		 -140%
(-450% to -6%)		 -25.6%
(-47.2% to -3.92%)		 -4
(-28 to -2)

Comments

  1. The study was too small to show any difference between the two groups for acute confusion.

Citation

  1. Christe C, Janssens JP, Armenian B, et al: midazolam sedation for upper gastrointestinal endoscopy in older persons: a randomized, double-blind, placebo-controlled study. J Am Geriatr Soc 2000; 48 : 1398-1403
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Contributor: Chris Ball, January 2002
Reviewer:

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