Sedation with meperidine and midazolam in pediatric patients undergoing endoscopy

We conducted a randomized, double-blind trial evaluating the efficacy and safety of meperidine 2 mg·kg^- (M) and meperidine 2 mg·kg^- plus midazolam 0.05 mg·kg^- (M+M) in 40 pediatric outpatients (age 1 to 17 years) undergoing upper endoscopy procedures. The physician and nurse performing the procedure were asked to rate cooperation, emotional status, drowsiness, and overall efficacy. A blinded observer recorded the frequency of negative behaviors indicating distress, vital signs, and oxygen saturation before, during, and after the procedure. No significant differences were noted in the overall efficacy of the regimens. Good or excellent efficacy was noted in 15 of 21 children (71%) in the M group and 15 of 19 children (79%) in the M+M group by physicians; nurses assigned a good or excellent rating for 14 of 21 (67%) and 13 of 19 (68%) in the M and M+M groups, respectively. Immediately following the procedure, amnesia was noted in 4 of 17 (23%) patients who received M versus 14 of 18 (78%) patients who received M+M (P=0.002). Of the children who received M+M, the amnesia tended to occur more frequently in older children (>11 years, 8 children, rate of amnesia 100%) than in younger children (≤11 years, 6 of 10 evaluable children, rate of amnesia 60%). There was no significant difference between the frequency of negative behaviors, rate of adverse effects, or changes in vital signs or oxygen saturation noted with the two drug regimens. We conclude that although the two sedation regimens produced similar efficacy, the combination of M+M may be preferred over M alone to enhance amnesia. Additional trials of M+M for sedation prior to other procedures are needed.