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. 2017 Dec 26:22:133.
doi: 10.4103/jrms.JRMS_432_17. eCollection 2017.

Premedication with benzodiazepines for upper gastrointestinal endoscopy: Comparison between oral midazolam and sublingual alprazolam

Vahid Sebghatollahi  1 , Elham Tabesh  1 , Ali Gholamrezaei  2 , Amir Reza Zandi  3 , Mohammad Minakari  1 , Ahmad Shavakhi  1
Affiliations

Premedication with benzodiazepines for upper gastrointestinal endoscopy: Comparison between oral midazolam and sublingual alprazolam

Vahid Sebghatollahi et al. J Res Med Sci. .

Abstract

Background: Premedication with orally administered benzodiazepines is effective in reducing anxiety and discomfort related to endoscopic procedures. We evaluated the efficacy and safety of oral midazolam in comparison to sublingual alprazolam as premedication for esophagogastroduodenoscopy (EGD).

Materials and methods: Adult candidates for diagnostic EGD received either oral midazolam (7.5 mg in 15 cc apple juice) or sublingual alprazolam (0.5 mg) 30 min before EGD. Procedural anxiety and pain/discomfort were assessed using 11-point numerical rating scales. Patients' overall tolerance (using a four-point Likert scale) and willingness to repeat the EGD, if necessary, were also assessed. Blood pressure, heart rate, and arterial oxygen saturation were monitored from medication to 30 min after the procedure.

Results: Patients experienced a similar reduction in procedural anxiety after medication with oral midazolam and sublingual alprazolam; mean (standard deviation [SD] of 1.86 [1.63] and 2.02 [1.99] points, respectively, P = 0.91). Compared to oral midazolam, pain/discomfort scores were lower with sublingual alprazolam; mean (SD) of 4.80 (3.01) versus 3.68 (3.28), P = 0.024. There was no significant difference between the two groups in patients' tolerance, willingness to repeat the procedure, or hemodynamic events.

Conclusion: Oral midazolam and sublingual alprazolam are equally effective in reducing EGD-related anxiety; however, EGD-related pain/discomfort is lower with alprazolam. Both benzodiazepines are equally safe and can be used as premedication for patients undergoing diagnostic EGD.

Keywords: Anxiety; benzodiazepines; endoscopy; esophagogastroduodenoscopy; premedication; sedation.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Patient flow diagram
Figure 2
Figure 2
Systolic blood pressure (±1 standard error of the mean) at baseline and during and after endoscopy. *Significant Group X time interaction and between-group difference, P < 0.05
Figure 3
Figure 3
Heart rate (±1 standard error of the mean) at baseline and during and after endoscopy. *Significant between-group difference using Mann–Whitney U-test (P < 0.05)
Figure 4
Figure 4
Arterial oxygen saturation (±1 standard error of the mean) at baseline and during and after endoscopy. No significant Group X time interaction or between-group difference (P > 0.05)
See this image and copyright information in PMC

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