File(s) stored somewhere else

Please note: Linked content is NOT stored on CQUniversity and we can't guarantee its availability, quality, security or accept any liability.

A prospective observational cohort pilot study of the association between midazolam use and delirium in elderly endoscopy patients

journal contribution
posted on 24.09.2021, 00:30 by Dickson Lee, Fiona Petersen, Maurice Wu, Gwenda Chapman, Melanie HaymanMelanie Hayman, Kerrilyn J Tomkins, Jeremy Fernando
Background: Midazolam is a benzodiazepine commonly used in procedural sedation and general anaesthesia. Current anaesthetic guidelines advise the avoidance of benzodiazepines in elderly patients due to concerns of an increased risk of delirium. Delirium is associated with significant patient morbidity and mortality, while also increasing health costs. Despite this, midazolam is often used in elderly patients undergoing low risk procedures due to the benefits of rapid onset, anxiolysis and haemodynamic stability compared to other sedatives. To date, studies describing the relationship between midazolam use and delirium in elderly patients undergoing low risk procedures, such as endoscopy, are limited. Method: This was a prospective observational cohort pilot study identifying the prevalence of delirium pre-procedure and incidence of delirium post-procedure in elderly endoscopy patients receiving midazolam. The study population was elderly patients greater than 65 years of age, without underlying cognitive dysfunction, undergoing elective endoscopy. Electronic databases were used for collection of demographic and clinical information. Delirium was identified through the administration of the Family Confusion Assessment Method survey; this was administered to carers of the study population 24–48 h pre and post procedure to categorically identify the presence or absence of delirium. Results: Fifty-eight participants were recruited for this study and eighteen were subsequently excluded based upon additional exclusion criteria. Forty patients were included in the final results. American Society of Anaesthesiology Classification (ASA) of patients were as follows: 1 (9 patients), 2 (12 Patients), 3 (16 Patients) and 4 (3 patients). Patients underwent gastroscopy, colonoscopy or combined gastroscopy and colonoscopy. This study identified no cases of delirium in elderly patients after administration of midazolam for elective endoscopy procedures 24–48 h post-procedure. Additionally, a high proportion of elderly patients were found to have received midazolam. Conclusion: No episodes of delirium were identified in this study. This finding runs counter to current guideline recommendations regarding midazolam use in the elderly patient and that elderly patients undergoing elective endoscopy represent a significantly different patient population compared to those previously studied. This study suggests that in the study population that the risk of delirium in patients exposed to midazolam in elective endoscopy was not demonstrated and that it may be safe to perform experimental studies to elucidate the safety of midazolam in larger studies.

History

Volume

21

Issue

1

Start Page

1

End Page

7

Number of Pages

7

eISSN

1471-2253

ISSN

1471-2253

Location

England

Publisher

BMC

Publisher License

CC BY

Additional Rights

CC BY 4.0

Language

eng

Peer Reviewed

Yes

Open Access

Yes

Acceptance Date

08/02/2021

External Author Affiliations

Rockhampton Hospital; The University of Queensland Rural Clinical School; St. Vincent's Hospital Toowoomba

Author Research Institute

Appleton Institute

Era Eligible

Yes

Medium

Electronic

Journal

BMC Anesthesiology

Article Number

53