Safety of midazolam for sedation of HIV-positive patients undergoing colonoscopy
Article first published online: 18 JAN 2013
© 2013 British HIV Association
Volume 14, Issue 6, pages 379–384, July 2013
How to Cite
Backman, E., Triant, V., Ehrenfeld, J., Lu, Z., Arpino, P., Losina, E. and Gandhi, R. (2013), Safety of midazolam for sedation of HIV-positive patients undergoing colonoscopy. HIV Medicine, 14: 379–384. doi: 10.1111/hiv.12014
- Issue published online: 6 JUN 2013
- Article first published online: 18 JAN 2013
- Manuscript Accepted: 29 NOV 2012
- National Institutes of Health (NIH). Grant Numbers: R01 AI066992-04A1, NIH G08LM008830-01, NIH U01 AI 694722, NIH 2P30 AI060354-06
Because of concerns regarding interactions between midazolam and antiretroviral therapy (ART), alternative sedatives are sometimes used during procedural sedation. Our objective was to compare outcomes in patients on ART who received intravenous (iv) midazolam vs. iv diazepam, a second-line agent, during colonoscopy.
We conducted a retrospective analysis of adult HIV-positive patients who underwent colonoscopy over a 3.5-year period. Primary outcomes were sedation duration, nadir systolic blood pressure (SBP), nadir oxygen saturation, abnormal cardiac rhythm, and change in level of consciousness using a standardized scale. We calculated rates of adverse events according to benzodiazepine use and identified risk factors for complications using univariate and multivariate analyses.
We identified 136 patients for this analysis: 70 received midazolam-based sedation and 66 received a diazepam-based regimen. There were no significant differences between the two groups with respect to sedation duration (mean 48.0 vs. 45.7 minutes for the midazolam and diazepam groups, respectively; P = 0.68), nadir SBP (mean 97.0 vs. 101.6 mmHg; P = 0.06), nadir oxygen saturation (mean 94.6 vs. 94.8%; P = 0.72) or rate of abnormal cardiac rhythm (11.4 vs. 19.7%; P = 0.18). More patients in the midazolam group experienced a depressed level of consciousness (91% vs. 74% in the diazepam group; P = 0.0075), but no patient required reversal of sedation or became unresponsive.
We did not find evidence that patients who received midazolam for procedural sedation had clinical outcomes statistically different from those who received diazepam. These findings should be confirmed in prospective studies or in a randomized controlled trial.