Conventional sedation regimens for endoscopic retrograde cholangipancreatography (ERCP) consist of intravenous benzodiazepines and opiates.
However, standardized dosing regimens for individual patients do not exist.
Dr Todd Baron and colleagues from Minnesota determined sedative doses in patients with and without a history of narcotic or benzodiazepine use.
The team assessed the frequency of reversal agent utilization, and potential predictive factors for reversal agent utilization.
The research team collected clinical data from 2004 to 2005.
The data were abstracted from a computerized endoscopy database to determine demographics, and median sedation dosages.
|6% reported routine use of narcotics|
|The American Journal of Gastroenterology|
The researchers evaluated the risk of reversal agent use, and clinical outcome related to sedation.
Univariate and logistic regression analysis were performed to assess independent predictive factors for reversal agent utilization.
The researchers assessed 3179 patients undergoing endoscopic retrograde cholangipancreatography.
Of these patients, 3058 received sedation directed by the endoscopists.
Meperidine and midazolam were given at a median dose of 125 mg and 7 mg, respectively, during a mean procedure time of 42 minutes.
The researchers found that 6% of patients reported routine use of narcotics or benzodiazepines.
The team noted these patients were younger, predominantly female, and required higher doses of meperidine and midazolam.
The research team observed that the patients received promethazine during procedural sedation more than those not using narcotics or benzodiazepines.
The team found that 4% of patients required reversal agents.
The patients were relatively older, required higher doses of meperidine and received promethazine more frequently than the nonreversed group.
Dr Baron's team concluded, “In a single, high volume endoscopic retrograde cholangipancreatography center, endoscopist administered sedation was provided in 96% of cases.”
“Patient age over 80 years, dose of meperidine, and the use of promethazine were independent risk factors for the need of reversal agents.”