Pethidine midazolam

A 43 year old man was premedicated for endoscopy with intravenous midazolam 2 mg and pethidine 50 mg). He immediately became agitated and restless. His blood pressure rose to 180/100 mmHg, he sweated, had widely dilated pupils, and had diarrhea. Over the next 90 minutes his condition remitted without specific treatment. He then reported that he had been taking fluoxetine (20 mg every other day), which he had stopped taken about 2 weeks before. 

Rectal pethidine is not advised in children, owing to enormous variability in systemic availability (SEDA-18, 82). When used for sedation in children undergoing eso-phagogastroduodenoscopy, hypoxia with dysrhythmias was more likely to occur with a combination of pethidine and diazepam than with pethidine and midazolam (SEDA-18, 81). 

A 61-year-old woman was given 15 ml of lidocaine solution 2% and lidocaine spray 4% for topical anesthesia of the throat and oropharynx before upper gastrointestinal endoscopy. She was also sedated with intravenous midazolam 2 mg and pethidine 75 mg. She became cyanosed and desaturated (Sp02 78%) immediately after the procedure. Her Sp02 did not recover, despite 100% oxygen. Her methemoglobin concentration was 37%. 

In a multicenter, double-blind, placebo-controlled study of the effects of intravenous flumazenil 0.7 mg in reversing the effects of midazolam, 82% of 131 flumazenil-treated patients had complete reversal of sedation, compared with 15% of 65 placebo-treated patients. However, flumazenil reversed midazolam-induced amnesia in only 60% of patients. Dizziness (10%) and nausea (9%) were the most common adverse effects [96 ]. Similar results were obtained in a double-blind, placebo-controlled study in patients who had been given midazolam plus an opioid (fentanyl, pethidine, or morphine) [97 ], intravenous diazepam [98 "], or diazepam plus an opioid [99 ]. 

The entire LITT treatment is performed using local anesthesia and intravenously injected analgesics [Pethidin 10-80 mg (Dolantin, Aventis Pharma, Frankfurt, Germany) and/or Piritramid 5-15 mg (Dipidolor, Janssen-CILAG, Neuss, Germany)] and sedation (2-10 mg midazolam, Hoffmann-La Roche, Grenzach-Wyhlen, Germany). 

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