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Year : 2017  |  Volume : 22  |  Issue : 1  |  Page : 133

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

1 Department of Internal Medicine, Division of Gastroenterology, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
3 Medical Student's Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Correspondence Address:
Dr. Elham Tabesh
Department of Internal Medicine, Isfahan University of Medical Sciences, Hezar Jarib Street, Isfahan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jrms.JRMS_432_17

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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(7.5mg in 15 cc apple juice) or sublingual alprazolam(0.5mg) 30min 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 30min 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.

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