8/6/2019 Aplikimi i mit Te Procedurat Endoskopike Eng

1/2

P

1

INTRAVENOUS APPLICATION OF MIDAZOLAM AT ENDOSCOPIC PROCEDURES

Dr. Adem Bytyqi, Dr. Fadil Kryeziu, Agron Bytyqi-BSc, Bashkim Sylaj

Introduction: Midazolam is benzodiazepine soluble in water, quite suitable for

premedication, sedation and induction to anesthesia. Midazolam is anxiolytic,hypnotic, anti-convulsant, muscle relaxation and cause of anterograde amnesia.These features make midazolam quite suitable to perform difficulty and unpleasantprocedures of endoscopic procedures such as: bronchoscope, gastro scope, heartand blood vessels catheterization, conversion of heart rhythm, CT diagnostic atpsychic patients concerned.

Methodology: In the study are included patients aged 20-70 years ASA IIand ASA III. Patients were treated at the lung ward and ambulatory patients.In order to describe our experience we made with 50 patients underbronchoscope sedated with midazolam. Patients were informed in advanceabout the benefits and possible complication during this procedure. After

information the patient signed the consent which is informed for continuumand possible complication and allows performing procedure. Patients beforethe intervention is established intravenous route. During the bronchoscopeintervention to patient is placed ECG monitoring, pulse oximeter, andnoninvasive BP measure, all these parameters are measured every 5minutes via display monitor. Midazolam is applied I.V. slowly in the bolusdose from 0.08 mg/kg/ of body weight. At elderly patients (ASA classificationII / III) midazolam dose was 3-5 mg. After giving i.v. midazolam within 2-3minutes patients were sunk in sleep, but they have answered the call byopening the eyes and the implementation of orders issued duringbronchoscope procedures. After midazolam action we have not had any

shaking in the frequency of the heart, BP, SpO2.Bronchoscopia was made with optical fiber bronchoscope carry through thenose.During the introduction of bronchoscope through trachea, patients have hadcoughing where immediately was given local anesthetic. Bronchoscopeprocedure lasted 25-80 minutes. During the intervention was not addedmidazolam.

While performing bronchoscope procedure has become to light increase ofBP and frequency of heart, and decrease of SpO2 to 85%.After performing the procedure patients were drowsily and disartric. Givingflumazenil 0.2 mg i.v., after 15 sec causes spontaneous eye opening, raisingthe head and awaking the patient which surprised ask whether theintervention was conducted and nothing was remembered. Some patientswho had previously been done the procedure without sedation, afterapplication of this method with noted that this method is better (appropriate)for performing of bronchoscope procedure.

8/6/2019 Aplikimi i mit Te Procedurat Endoskopike Eng

2/2

P

1

One patient was disoriented and concerned with providing midazolam,patient was elderly.

Results: Endoscopic procedures are more desirable (acceptable) with theadded sedation i.v. with midazolam in doses from 0.08 mg/kg of body weight

should not exceed this dose to maintain the patients consciousness. Forantagonism of sedation based on our experience are enough doses of 0.2-0.6mg i.v. of flumazenil. At these interventions are not recommendedmidazolam combinations with narcotics. Midazolam dose should reduce atelderly patients, at heavy sick and immobile dose is 3-5 mg. Duringendoscopic procedures with intravenous sedation must be monitored withECG, BP, pulse, SpO2 and reanimation bags to be alert.

Efficiency determination of midazolam

Awarenesssituation

0 1 2 3 4 Total

Number ofpatients

- 37

10

3 - 50

0 - Fully awake1 - Sleepy, relaxed, maintained communication2 - Little deep sleep3 The patient sleep (somnolent) the possibility of easy awaking4 Deep sleep should not be allowed.

Efficiency determination

poor good excellent

0 31 19

Conclusion: Flumazenil in safely and efficiently performed reversion ofsedation with midazolam, but not amnesia in earlier periods. Residualsedation at short interventions is possible after 30-60 minutes: Endoscopicprocedures are more desirable (acceptable) with added sedation i.v. Withmidazolam in doses of 0.1 mg/kg of body weight should not exceed this doseto the patients with maintained conscious. For antagonism of sedationsufficient doses are from 0.2-0.6 mg i.v. of flumazenil.

Literature:1. Whitwam J.G. The use of Midazolam and Flumazenil in diagnostic and shortsurgical procedures. Acta Anaesthesiol.scand.1990 34, suppl.92-16-20.2. Use of Midazolam and flumazenil in paediatric bronchology: BaktaiG,Szekly PMID:1582237 (PubMed-indexed for MEDLINE).3. British Thoracic Society guidelines on diagnostic flexible bronchoscopy.