Success Rate of Sedation in Esophagogastroduodenoscopy using Fentanyl and Midazolam in Combination with Topical Lidocaine
Saipin Muangman MD*, Somchai Amornyotin MD*, Peerachatra Mangmeesri MD*, Saowapark Chumpathong MD*, Nonthalee Pausawasdi MD**, Watcharasak Chotiwaputta MD**, Julajak Limsrivilai MD**, Oranee Svastdi-xuto BNS*, Tassanee Jaiyen BNS*, Choopong Luansritisakul MD*
Affiliation : * Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To evaluate the success rate of moderate sedation with fentanyl and midazolam combined with topical lidocaine in
esophagogastroduodenoscopy (EGD), relative to level of patients and endoscopists’ satisfaction, time to recovery, and
associated complications.
Material and Method: Patients undergoing EGD were given topical lidocaine at the pharyngeal area and intravenous
sedation with a combination of fentanyl 1 mcg/kg and midazolam 20 mcg/kg. In patients who could not tolerate EGD, an
additional dose of fentanyl 0.5 mcg/kg and midazolam 10 mcg/kg was administered. Patients who continued to demonstrate
intolerance to EGD were given a bolus dose of propofol 1 mg/kg, followed by propofol infusion 2 to 5 mg/kg/hr. Success was
defined as completion of EGD procedure using fentanyl and midazolam sedation only, with no observation of patient
intolerance. After the procedure, patients and endoscopists’ satisfaction was evaluated.
Results : Eighty-two patients were enrolled in this study. Success rate of the studied sedation protocol was 100%, but two
patients required an additional dose of fentanyl and midazolam. Seventy-six participants (92.7%) were satisfied with the
sedation technique, and 100% of endoscopists reported being either satisfied or very satisfied. The average time to following
verbal commands after completion of the procedure was 1.4 minutes. Desaturation was observed in one patient, which was
corrected by jaw-thrust maneuver and increased oxygen flow.
Conclusion : Intravenous fentanyl and midazolam combined with topical lidocaine in EGD yielded good results and a high
level of satisfaction among both patients and endoscopists with some acceptable complications.
Keywords : Esophagogastroduodenoscopy, Intravenous sedation, success rate, Fentanyl, midazolam, Topical lidocaine
