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Propofol-alfentanyl versus midazolam-alfentanyl in inducing procedural amnesia of upper gastrointestinal endoscopy in children—blind randomised trial

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Abstract

In paediatric patients, esophagogastroduodenoscopy (EGD) is commonly performed with the use of sedation. The aim of the study was to compare the effectiveness of propofol and midazolam in providing procedural amnesia and controlling behaviour in children undergoing diagnostic EGD. Children (9–16 years), classified to the first or second class of the American Society of Anaesthesiologists’ physical status classification referred for EGD, were randomly assigned to receive propofol with alfentanyl or midazolam with alfentanyl for sedation during the procedure. Within 120 min after the procedure, patients were repeatedly investigated for memory of the procedure and for memory of pain intensity during EGD with the use of the visual analogue scale. Activity and cooperation of the patient during the procedure was assessed with the relative adequacy scale. Of the 51 children, 48 completed the study. Propofol was significantly better than midazolam in inducing amnesia of procedural pain (mean difference 11.53 mm; 95 % confidence interval [CI] 0.96 to 22.10), loss of memory of the procedure (relative risk 0.4; 95 % CI 0.21 to 0.59) and controlling behaviour (relative risk 2.12; 95 % CI 1.33 to 3.36).

Conclusion: In children sedated for EGD, propofol is significantly better than midazolam at providing procedural amnesia and controlling behaviour during the procedure.

What is known:

• There is still the matter of debate what is the most safe and effective way to provide sedation for paediatric esophagogastroduodenoscopy in children.

What is new:

• In children sedated for gastroduodensocopy propofol is significantly better than midazolam at providing amnesia, reported procedural pain and controlling behaviour during the procedure.

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Abbreviations

CI:

Confidence interval

EGD:

Esophagogastroduodenoscopy

MD:

Mean difference

ML:

Midazolam

PF:

Propofol

RAS:

Relative adequacy scale

RR:

Relative risk

VAS:

Visual analogue scale

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Acknowledgments

We would like to thank Beata Korus our paediatric endoscopy nurse for her cooperation in performing this trial.

Conflict of interest

This work was funded by the Medical University of Warsaw. The authors declare that no financial or other conflicts of interest exist in relation to the content of the article.

Authors’ contribution

ES and PD initially conceptualised this study. All authors contributed to the study protocol. ES, JZ and PD were responsible for data collection, data analysis, data interpretation, and preparation of the report. AP contributed to data analysis and data interpretation. ES and PD assumed the main responsibility for the writing of the first draft of this manuscript. All authors contributed to (and agreed upon) the final version.

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Authors and Affiliations

  1. Department of Paediatric Gastroenterology and Nutrition, The Medical University of Warsaw, Dzialdowska 1, 01-184, Warsaw, Poland

    Edyta Sienkiewicz & Piotr Albrecht

  2. Department of Paediatric Anesthesiology and Intensive Therapy, The Medical University of Warsaw, Dzialdowska 1, 01-184, Warsaw, Poland

    Janusz Ziółkowski

  3. Department of Paediatrics, The Medical University of Warsaw, Dzialdowska 1, 01-184, Warsaw, Poland

    Piotr Dziechciarz

Authors
  1. Edyta Sienkiewicz
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  2. Piotr Albrecht
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  3. Janusz Ziółkowski
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  4. Piotr Dziechciarz
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Corresponding author

Correspondence to Piotr Dziechciarz.

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Communicated by Peter de Winter

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Sienkiewicz, E., Albrecht, P., Ziółkowski, J. et al. Propofol-alfentanyl versus midazolam-alfentanyl in inducing procedural amnesia of upper gastrointestinal endoscopy in children—blind randomised trial. Eur J Pediatr 174, 1475–1480 (2015). https://doi.org/10.1007/s00431-015-2555-z

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  • DOI: https://doi.org/10.1007/s00431-015-2555-z

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