Does alteration of conscious sedation dosage influence patient's perception of the endoscopic procedures?

The type and quantity of drugs used for conscious sedation may influence patient's perception and tolerance for endoscopie procedures. Aim: To compare outcomes in Pt's comfort and attitude towards endoscopy when different doses of benzodiazepines were used. Methods: Pts were randomized to midazolam at 1/4th requested dose (GI); diazepam (GII) or midazolam (GIII) at the requested doses. MDs were blinded, but meperidine was used at their discretion. Pts receiving only meperidine=GIV. Time between first drug and start of the procedure (sedation), time for procedure completion, and doses were recorded. Pt's comfort was graded by MD, RN and Pt :comfortable=1; mild discomfort=2; moderate=3; severe=4. Pts assessed level of amnesia, willingness to have the procedure again and whether they thought had enough sedation. Pts were interviewed again 24 hours later. We used Chi-square and T tests. Results: There were 113 EGDs: GI=29, GII=29. GIII=44, GIV=11; and 77 Colonoscopics:GI=18, GII=19, GIII=29, GIV=11. Mean doses (mg) are shown: Group 1 Group II Group III Group IV Midaz Meper Diaz Meper Midaz Meper Benzo Meper EGD 0.5±.06 29.3±3.9 3.2±.36 38.4±5.7 1.94±.13 30.7±3.9 0 47.7±4.1 Colon 0.43±.07 38.9±4.6 2.3±.33 43.4±4.2 1.6±12 46.6±3.2 0 47.7±2.3 Sedation and procedure times (min.) are shown below (*p<0.05): Sedation Time (min.)±SEM Procedure Time (min.)±SEM GI GII GIII GIV GI GII GIII GIV EGD 67±7* 9.8±1.5 9.2±.8* 5.2±1.4* 10.1±1.0 12.1±1.1 10.5±1.2 10.7±1.8 Colon 5.7±.8 7.2±.9* 7.0±1.2 3.8±.5* 22.6±2.6* 23.7±2.5 28.8±4.5 32.4*4.2* For EGD, the discomfort score as assessed by the patient was lower in Groups I and IV compared to Group II and for colonoscopy, lower in Group IV than the other 3 groups (*p<0.05): GI GII GIII GIV Overall EGD 1.7±.12* 2.1±.17* 1.8±.14 1.5±.2* 1.8±.7 Colon 2.2±.21* 2.2±.19* 2.1±.18* 1.5±.15* 2.0±.8 Overall. 88%, 79% and 92.5% of Pts recalled the procedure, thought had enough sedation and were willing to have the procedure again, respectively. There were no differences amongst the groups. None of these perceptions nor the perception of comfort changed with time. Conclusion: At the doses tested, there were no statistical differences in patient's comfort and attitude towards endoscopy. between high and lower dose of midazolam nor diazepam.