Safety of midazolam for sedation of HIV-positive patients undergoing colonoscopy. HIV Med 2013 Jul;14(6):379-84
Date
01/22/2013Pubmed ID
23332038Pubmed Central ID
PMC4120820DOI
10.1111/hiv.12014Scopus ID
2-s2.0-84878914454 (requires institutional sign-in at Scopus site) 1 CitationAbstract
OBJECTIVES: Because of concerns regarding interactions between midazolam and antiretroviral therapy (ART), alternative sedatives are sometimes used during procedural sedation. Our objective was to compare outcomes in patients on ART who received intravenous (iv) midazolam vs. iv diazepam, a second-line agent, during colonoscopy.
METHODS: We conducted a retrospective analysis of adult HIV-positive patients who underwent colonoscopy over a 3.5-year period. Primary outcomes were sedation duration, nadir systolic blood pressure (SBP), nadir oxygen saturation, abnormal cardiac rhythm, and change in level of consciousness using a standardized scale. We calculated rates of adverse events according to benzodiazepine use and identified risk factors for complications using univariate and multivariate analyses.
RESULTS: We identified 136 patients for this analysis: 70 received midazolam-based sedation and 66 received a diazepam-based regimen. There were no significant differences between the two groups with respect to sedation duration (mean 48.0 vs. 45.7 minutes for the midazolam and diazepam groups, respectively; P = 0.68), nadir SBP (mean 97.0 vs. 101.6 mmHg; P = 0.06), nadir oxygen saturation (mean 94.6 vs. 94.8%; P = 0.72) or rate of abnormal cardiac rhythm (11.4 vs. 19.7%; P = 0.18). More patients in the midazolam group experienced a depressed level of consciousness (91% vs. 74% in the diazepam group; P = 0.0075), but no patient required reversal of sedation or became unresponsive.
CONCLUSIONS: We did not find evidence that patients who received midazolam for procedural sedation had clinical outcomes statistically different from those who received diazepam. These findings should be confirmed in prospective studies or in a randomized controlled trial.
Author List
Backman ES, Triant VA, Ehrenfeld JM, Lu Z, Arpino P, Losina E, Gandhi RTAuthor
Jesse Ehrenfeld MD, MPH Sr Associate Dean, Director, Professor in the Advancing a Healthier Wisconsin Endowment department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAnesthetics, Intravenous
Colonoscopy
Diazepam
Drug-Related Side Effects and Adverse Reactions
Female
HIV Infections
Humans
Male
Midazolam
Middle Aged
Retrospective Studies
