Jin EH, Song JH, Lee J, Bae JH, Chung SJ. Midazolam dose is associated with recurrence of paradoxical reactions during endoscopy. World J Clin Cases 2021; 9(29): 8763-8772 [PMID: 34734054 DOI: 10.12998/wjcc.v9.i29.8763]
Corresponding Author of This Article
Ji Hyun Song, MD, PhD, Professor, Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, 39F Gangnam Finance Center, 152 Teheran-ro, Gangnam-gu, Seoul 06236, South Korea. philomed@hanmail.net
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Oct 16, 2021; 9(29): 8763-8772 Published online Oct 16, 2021. doi: 10.12998/wjcc.v9.i29.8763
Midazolam dose is associated with recurrence of paradoxical reactions during endoscopy
Eun Hyo Jin, Ji Hyun Song, Jooyoung Lee, Jung Ho Bae, Su Jin Chung
Eun Hyo Jin, Ji Hyun Song, Jooyoung Lee, Jung Ho Bae, Su Jin Chung, Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul 06236, South Korea
Author contributions: Song JH contributed to conception and design; Jin EH did the analysis and interpretation of the data, drafting of the article; Lee J, Bae JH and Chung SJ did the critical revision of the article for important intellectual content; all authors approved the final version of the article.
Institutional review board statement: This study protocol conformed with the ethical guidelines of the 1975 Declaration of Helsinki and its subsequent revisions and was approved by the relevant institutional review board, No. H-1710-023-890.
Informed consent statement: Informed consent was not needed for this study.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: The presented data are anonymized and the risk of identification is low and the potential benefits of sharing these data outweigh the potential harms.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ji Hyun Song, MD, PhD, Professor, Department of Internal Medicine, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, 39F Gangnam Finance Center, 152 Teheran-ro, Gangnam-gu, Seoul 06236, South Korea. philomed@hanmail.net
Received: June 11, 2021 Peer-review started: June 11, 2021 First decision: June 25, 2021 Revised: June 26, 2021 Accepted: August 31, 2021 Article in press: August 31, 2021 Published online: October 16, 2021 Processing time: 126 Days and 5.1 Hours
ARTICLE HIGHLIGHTS
Research background
Some patients experience paradoxical reactions characterized by excessive movement or excitement during midazolam sedation.
Research motivation
Because paradoxical reactions of midazolam are specific to an individual, they are likely to recur on the next endoscopy. However, there are only a few studies on the recurrence of paradoxical reactions.
Research objectives
We investigated the recurrence rate and risk factors associated with recurrent paradoxical reactions. Our findings may be helpful when patients with a history of paradoxical reactions undergo endoscopy under sedation again.
Research methods
We enrolled 361 patients with a history of paradoxical reactions during a sedative upper endoscopy. At a follow-up examination, patients with recurrent paradoxical reactions (recurrent group) and those without recurrence (non-recurrent group) were compared.
Research results
We report, for the first time, that the rate of recurrence of paradoxical reactions is significantly associated with the dose of midazolam administered.
Research conclusions
To avoid the recurrence of such reactions, we recommend reducing the total dose of midazolam administered to patients with previous paradoxical reactions by ≥ 2 mg compared to the dose previously used.
Research perspectives
Large-scale prospective studies investigating genetic factors are needed to elucidate the mechanisms of paradoxical reactions.
