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PubMed2003

A comparison of the effects of epidural and meperidine analgesia during labor on fetal heart rate.

OBJECTIVE: To estimate the effects of initiation of epidural analgesia on fetal heart rate (FHR) patterns compared with intravenous meperidine analgesia. METHODS: Fetal heart rate patterns in 200 nulliparous women with term pregnancies randomized to epidural analgesia with 0.25% bupivacaine were compared with those of 156 similar women given intravenous meperidine. Fetal heart rate patterns occurring within 40 minutes of initiation of labor analgesia were retrospectively read by three maternal-fetal medicine specialists who were blind to clinical events, including type of labor analgesia. RESULTS: Meperidine, compared with epidural analgesia, was associated with statistically significantly less beat-to-beat variability (absent or less than 5 beats per minute) of the FHR (30% versus 7% of fetuses, P <.001) in the first 40 minutes after initiation of analgesia, as well as with fewer FHR accelerations (88% versus 62% of fetuses, P <.001). Neither the incidence of FHR decelerations nor the type of deceleration were significantly different between methods of labor analgesia. Specifically, 41% of women given meperidine exhibited FHR decelerations within 40 minutes, compared with 34% given epidural analgesia (P =.353). CONCLUSION: Epidural analgesia does not have deleterious effects on FHR.

Adult↗
PubMed1987

A double-blind comparison of nalbuphine and meperidine hydrochloride as intravenous analgesics in combination with diazepam for oral surgery outpatients.

This study compared the analgesic efficacy, sedative, and amnesic properties, and side effects of nalbuphine versus meperidine as intravenous premedicants in combination with intravenous diazepam for the treatment of outpatients undergoing the removal of impacted third molars with alveolar nerve block anesthesia. Forty patients were evaluated in this double-blind crossover study. Nalbuphine was shown to have analgesic, sedative, and amnesic properties similar to meperidine. Nalbuphine, when compared to meperidine, produced significantly lower intraoperative systolic and diastolic blood pressures. Because of this cardiovascular stability, nalbuphine should be considered over meperidine for use in the cardiovascularly compromised patient undergoing oral surgery.

Adolescent↗
PubMed2002

Postoperative nausea and vomiting: comparison of the effect of postoperative meperidine or morphine in gynecologic surgery patients.

STUDY OBJECTIVE: To evaluate the incidence and severity of postoperative nausea and vomiting in women receiving postoperative intravenous morphine or meperidine following gynecologic surgery. DESIGN: Prospective, double-blind, randomized study. SETTING: Tertiary-care academic medical center. PATIENTS: 200 ASA physical status I, II, and III patients scheduled for elective gynecologic surgery. INTERVENTIONS: Patients received either postoperative IV morphine (n = 100) or meperidine (n = 100) following gynecologic surgery. MEASUREMENTS: We compared pain scores, sedation scores, nausea scores, well-being scores, vomiting rate, and patient satisfaction in both groups 15, 30, 60, and 120 minutes after arrival in the postoperative anesthesia care unit. MAIN RESULTS: The vomiting rate was 8/100 versus 7/100 (at 15 min), 4/100 versus 26/100 (at 30 min) (p < 0.05), 3/100 versus 23/100 (at 60 min) (p < 0.05), and 0/100 versus 0/100 (at 120 min) in the morphine or meperidine groups, respectively. The pain and sedation scores were similar in both groups. No major complications were noted in either group. CONCLUSION: Our study demonstrates an advantage of the use of morphine rather than meperidine for pain control in the immediate postoperative period following gynecologic surgery.

Adult↗
PubMed2000

A quality improvement approach to reducing use of meperidine.

BACKGROUND: In 1991 the University of Wisconsin Hospital and Clinics formed a pain management QI team whose goal was to improve pain management through education, outcome monitoring, and the development of programs intended to improve clinical practice. Longitudinal monitoring mechanisms were established to audit medical records and survey patients to examine both staff practice patterns and patient outcomes. The QI team targeted use of meperidine, one of the most widely used opioid analgesics for the treatment of moderate to severe pain, which is now discouraged as a first-line agent for most painful conditions. IMPLEMENTING THE QI PROCESS: A QI process was implemented using a traditional plan-do-check-act (PDCA) model, resulting in a successful and sustained reduction of inappropriate meperidine use. A cause-and-effect diagram helped highlight the multiple factors contributing to the drug's overuse and was used to prioritize targets for action. A flow chart helped to uncover some of the interrelationships between the myths about meperidine and the resultant customary prescribing and administration practices. While most of the strategies were implemented in 1996 (formulary guideline release, change in stock supply and physician orders, staff education and feedback), a significant impact in practice was not seen until late 1997. Ongoing tracking and feedback loops were established to ensure continued low use of meperidine. CONCLUSION: Use of a QI approach in pain management has been shown to affect the visibility of pain as a clinical priority, enhance interdisciplinary collaboration, facilitate the implementation of clinical guidelines at the bedside, and improve the quality of care for patients.

Analgesics, Opioid↗
PubMed2005

Synthesis and biological evaluation of meperidine analogues at monoamine transporters.

A series of aryl-substituted meperidine analogues was synthesized, and the binding affinities were determined at the DAT, SERT, and NET as well as at mu-opioid receptors. Generally the analogues exhibited increased affinity for the DAT and SERT relative to meperidine but exhibited low binding affinity for the NET. The 2-naphthyl derivative 7f was the most potent ligand at the SERT (K(i) = 0.0072 muM) and was the most selective ligand for the SERT over the DAT (DAT/SERT = 158) and mu-opioid receptors (mu/SERT = 281). The 3,4-dichlorophenyl derivative 7e was the most potent ligand at the DAT (K(i) = 0.125 muM) and was the most selective ligand for the DAT over mu-opioid receptors (mu/DAT = 16.3) but remained slightly more selective for the SERT over the DAT(DAT/SERT = 6.68). Three compounds, the 3,4-dichlorophenyl derivative 7e and the 2-naphthyl analogues 6f and 7f, were identified that were more potent at the DAT than meperidine and that exhibited well-defined biphasic dopamine uptake inhibition similar to meperidine. However, none of the analogues tested produced locomotor effects or substituted for cocaine in drug discrimination studies, suggesting that the mu-opioid effects of these analogues may contribute to the poor efficacy observed in vivo.

Animals↗
PubMed2004

Comparison of fentanyl versus meperidine for analgesia in pediatric gastrointestinal endoscopy.

This study compared the safety and efficacy of fentanyl and meperidine for analgesia in pediatric gastrointestinal endoscopy. In a double-blind, randomized trial, 24 patients (11 males) received either fentanyl (1 microg/kg) or meperidine (1 mg/kg). These analgesics were administered in unmarked syringes by an investigator who did not participate in the procedure or in the evaluation of the patient's sedation. There were 17 Caucasians and 7 African-Americans whose mean age was 10.4 +/- 4.4 years. Thirteen patients received meperidine and 11 received fentanyl. Midazolam was given to all patients as needed to provide sufficient sedation for the procedure. Study subjects underwent EGD (n = 17) or colonoscopy (n = 7). There were no differences as assessed by patient, endoscopist, or assistant for tolerance, discomfort, procedure ease, recovery time, complications, heart rate, blood pressure, or oxygen saturation. We conclude that meperidine and fentanyl are equally effective in providing analgesia for pediatric gastrointestinal endoscopy.

Adolescent↗
PubMed1981

Presystemic metabolism of meperidine to normeperidine in normal and cirrhotic subjects.

Plasma concentrations and urinary excretion of meperidine and its metabolite normeperidine were determined after intravenous and oral administration to 11 men; five men had hepatic cirrhosis and six were normal. Systemic clearance of meperidine was smaller and bioavailability and half-life greater in the cirrhotic patients than in the normal subjects. Plasma concentrations and 24-hr urinary excretion of normeperidine was lower and persistence of normeperidine in plasma longer in the patients with cirrhosis. The route of administration did not alter the fraction of normeperidine generated from meperidine. The results suggest that in patients requiring repeated meperidine dosage the drug should be taken parenterally rather than orally to allow maximal analgesia and minimal formation of normeperidine. Patients with cirrhosis may be relatively protected from normeperidine toxicity because of impaired formation, but the risk of cumulative toxicity may be greater than in normal subjects because of slower elimination of the metabolite and greater sensitivity to the effects of narcotics on the central nervous system.

Administration, Oral↗
PubMed1981

Meperidine binding in maternal and fetal plasma.

Meperidine protein binding was measured in nine pairs of maternal and fetal plasma samples obtained at delivery. For the maternal samples, percent bound and binding ratio (bound/free, B/F) were 63.3 +/- 6.18% (SD) and 1.79 +/- 0.45, and for the fetal samples the corresponding values were 51.7 +/- 4.53% and 1.09 +/- 0.21. In each case the binding was higher in the mother than in the fetus (p less than 0.01). Plasma alpha 1-acid glycoprotein (alpha 1-AGP) concentrations were higher (p less than 0.01) in maternal than in fetal samples, and there was a correlation between meperidine B/F and plasma alpha 1-AGP concentration for the maternal and fetal samples (r = 0.752, p less than 0.01). Binding studies with purified alpha 1-AGP showed that this was a cause-effect relationship. The transplacental binding differential was attributable partially to the maternal-fetal difference of plasma alpha 1-AGP concentrations. Meperidine was 17.5 +/- 0.35% bound in a 3.5 gm/100 ml solution of human serum albumin; however, there was an inverse correlation (r = -0.798, p less than 0.01) between B/F and plasma albumin concentration for the maternal and fetal samples. A relatively large proportion (75%) of the overall variability in B/F was accounted for by plasma alpha 1-AGP and albumin. Plasma binding of this basic drug was not greatly influenced by the perinatal levels of bilirubin and nonesterified fatty acids. The common clinical observation of greater fetal than maternal plasma total meperidine concentrations at delivery is not the result of more extensive protein binding in fetal than in maternal plasma.

Adolescent↗
PubMed1997

Spinal anesthesia with meperidine. Effects of added alpha-adrenergic agonists: epinephrine versus clonidine.

We determined the effects of intrathecally administered epinephrine and clonidine on the duration and quality of a meperidine spinal block. Forty-five patients scheduled for orthopedic surgery, divided into three groups, received spinal anesthesia with 1 mg/kg 5% meperidine, alone or with 200 microg epinephrine or 2 microg/kg clonidine. Using a double-blind method, the onset, extension, and duration of sensory block (to pinprick) and the duration and degree of motor block (Bromage scale) were assessed. Hemodynamic responses, duration of postoperative analgesia, degree of sedation, and occurrence of side effects were also recorded. The addition of epinephrine to the meperidine solution prolonged the sensory block (P<0.01) but did not affect its onset or extent. A similar potentiating effect was demonstrated for clonidine (P<0.001). The duration and degree of motor block were increased by addition of both epinephrine and clonidine. A tendency toward bradycardia and a decrease of mean arterial pressure was potentiated by clonidine but not by the epinephrine. Only the addition of clonidine prolonged the postoperative analgesia (P<0.001), but was associated with an increased sedation score. The incidence of other side effects did not differ between the groups. We conclude that coadministration of epinephrine or clonidine with meperidine enhances the duration and degree of spinal anesthesia and that adding clonidine prolongs the duration of postoperative analgesia.

Adjuvants, Anesthesia↗
PubMed1997

Epidural meperidine after cesarean section: the effect of diluent volume.

We investigated the effect of diluent volume on analgesia and systemic absorption from epidural meperidine after cesarean section in a randomized, double-blind study. At the first request for postoperative analgesia, 36 parturients were given epidural meperidine 25 mg diluted with saline to either 2 mL (12.5 mg/mL), 5 mL (5 mg/mL), or 10 mL (2.5 mg/mL). Visual analog pain scores measured in the first 30 min were greater in the 2-mL group compared with both the 5-mL group (P = 0.028) and the 10-mL group (P = 0.031). Onset of analgesia (time for visual analog pain scores to decrease by 50%) was also slower in the 2-mL group (17.5 min) compared with the 5-mL group (9 min; P = 0.015) and the 10-mL group (12 min; P = 0.003); there were no differences between the 5-mL group and the 10-mL group. Duration of analgesia and plasma concentrations of meperidine were similar among groups. No adverse side effects were recorded. Previous work has suggested that injection of epidural opioids in large volumes increases the potential risk of respiratory depression from cephalad spread of the drug. Therefore, we conclude that analgesia is optimum when epidural meperidine is administered diluted to 5 mL.

Absorption↗
PubMed1999

Comparison of the sedation and recovery profiles of Ro 48-6791, a new benzodiazepine, and midazolam in combination with meperidine for outpatient endoscopic procedures.

UNLABELLED: In this randomized, double-blinded study, we compared the onset and recovery characteristics of an investigational benzodiazepine, Ro 48-6791 (when administered alone or combined with meperidine), a midazolam-meperidine combination for sedation during gastrointestinal (GI) endoscopic procedures. Ninety consenting outpatients scheduled for upper or lower GI procedures were randomly assigned as follows: Group I received midazolam 1 mg IV and meperidine 50 mg; Group II received Ro 48-6791 0.5 mg IV and meperidine 50 mg; or Group III received Ro 48-6791 1.0 mg IV alone. If the level of sedation did not achieve an Observer's Assessment of Alertness/Sedation (OAA/S) score of 4 (where 5 = awake/alert to 1 = asleep) in < or = 2 min, a second bolus dose, equal to half of the original dose of midazolam or Ro 48-6791, was administered. The onset time was defined as the time to achieve an OAA/S score of 4. During the procedure, a bolus dose equal to half of the total induction dose was given to maintain an OAA/S score of 4. The induction and maintenance dosages, as well as recovery times to an OAA/S score of 5, were recorded. A heel-toe line walk (HTLW) test used to determine the time to "fitness for discharge." Although the onset times were similar in all three groups, the induction dosages were significantly reduced in Group II compared with Groups I and III. There were significantly more patients requiring supplemental sedative boluses and "rescue" analgesia with Ro 48-6791 than with midazolam. The Ro 48-6791 groups also experienced more dizziness after the procedures. Ro 48-6791 was associated with a higher incidence of inadequate sedation (18% vs 3%) without the opioid. The time for the HTLW test to return to baseline values after the procedure was similar among the three groups. However, the Ro 48-6791 groups had significantly reduced times to return to an OAA/S score of 5 and to achieve the baseline HTLW value after the last dose of the benzodiazepine. In conclusion, compared with midazolam, Ro 48-6791 is more potent and may be associated with a more rapid early recovery after endoscopic GI procedures. However, sedation with Ro 48-6791 required more supplemental bolus doses and "rescue" analgesic medication and was associated with a higher incidence of dizziness. IMPLICATIONS: The investigational water-soluble benzodiazepine, Ro 48-6791, is a more potent sedative than midazolam, which appears to have a slightly shorter duration of action. Unfortunately, use of Ro 48-6791 increased the requirement for supplemental doses of the sedative medication and the need for "rescue" analgesics during the procedure and was associated with more dizziness after the procedure.

Adjuvants, Anesthesia↗
PubMed1975

Psychomotor skills related to driving after intramuscular administration of diazepam and meperidine.

Psychomotor skills related to driving and the ability to discriminate the fusion of flickering light were measured in a double-blind cross-over fashion in 11 healthy volunteers before, and 1, 3, 5, and 7 hours after, intramuscular injection of saline solution, 10 mg diazepam, or 75 mg meperidine. The late effects of meperidine were tested in five other subjects 12 and 24 hours after the injection. The effects of diazepam were the most harmful to coordinative and reactive skills, which were significantly impaired for as long as 5 hours. Meperidine impaired reactive skills for as long as 3 hours and flicker-fusion discrimination and coordinative skills for as long as 12 hours. It is concluded that patients should not drive or operate machinery for at least 7 hours after receiving 10 mg diazepam intramuscularly and for 24 hours after receiving 75 mg meperidine intramuscularly.

Adult↗
PubMed1980

Relationship between blood meperidine concentrations and analgesic response: a preliminary report.

Variability in analgesic responses to intramuscularly administered meperidine has been related to variable and unpredictable blood concentrations after injection. However, the contribution of variability in the relationship between blood concentration and effect has not been examined. The present study was designed to determine the relationship between blood meperidine concentrations and analgesic effects in nine patients during the first two postoperative days. Pain was estimated by subjective bioassay. The blood concentration-effect curves were steep, with a difference of as little as 0.05 microgram/ml between the mean concentrations associated with severe pain and those associated with effective analgesia. Each curve had two inflection points: the maximum concentration still associated with severe pain (MCP) (0.41 microgram/ml, SD = 0.17, n = 76) and the minimum effective analgesic concentration (MEAC) (0.46 microgram/ml, SD = 0.18, n = 19). Interpatient variability of MEAC was appreciable (coefficient of variation = 39 percent) and intrapatient variability was also detected. Variable pain control following intermittent intramuscular injections was shown to be due not only to variation in absorption, as reported previously, but also to variation in the blood meperidine concentration-analgesic response relationships. However, correlations were found between MCP and neuroticism and extroversion scores from a personality inventory and physical variables. Thus, equations that allow prediction of an individual's MCP were derived by multivariable regression. A blood meperidine concentration of 0.7 microgram/ml would be expected to provide freedom from severe pain in approximately 95 per cent of cases. An intravenous infusion regimen for achieving and maintaining this concentration is described.

Adult↗
PubMed1991

Double-blind comparison of oral transmucosal fentanyl citrate with oral meperidine, diazepam, and atropine as preanesthetic medication in children with congenital heart disease.

The effectiveness of oral transmucosal fentanyl citrate (OTFC) as preanesthetic medication was compared with oral meperidine, diazepam, and atropine (MDA) in 40 pediatric patients scheduled to undergo repair of congenital heart defects. In a double-blinded manner, patients received a fentanyl lollipop (20-25 micrograms/kg) and a placebo oral solution (0.4 ml/kg) (n = 20) or a placebo lollipop and an oral solution (0.4 ml/kg) of meperidine (1.5 mg/kg), diazepam (0.2 mg/kg), and atropine (0.02 mg/kg) (n = 20). The patient's vital signs, systolic and diastolic blood pressures, heart rate, respiratory rate, and oxyhemoglobin saturation (SpO2), as well as activity and apprehension scores were evaluated and recorded at baseline and at 10-min intervals. The patient's emotional status at the time of parental separation and at induction of anesthesia were also assessed. Side effects and onset of action were observed. After OTFC, onset of sedation was significantly faster than with the oral solution of meperidine, diazepam, and atropine. In both groups there was no significant change in heart rate. Although systolic blood pressure, diastolic blood pressure, and respiratory rate showed statistically significant decreases, these changes were not clinically significant. The child's emotional status at the time of separation from the parents and during induction was similar in both groups. Side effects with OTFC were more frequent: nose itching occurred in 65%, body itching in 10%, and vomiting in 30%. Two patients (10%) in the OTFC-treated group became hypoxemic (SpO2 less than 90) and required supplemental oxygen. In the group receiving oral meperidine, diazepam, and atropine, 10% had mild facial pruritus and 5% complained of a dry mouth.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1997

Cesarean delivery: a randomized trial of epidural versus patient-controlled meperidine analgesia during labor.

BACKGROUND: Reports indicate that the administration of epidural analgesia for pain relief during labor interferes with labor and increases cesarean deliveries. However, only a few controlled trials have assessed the effect of epidural analgesia on the incidence of cesarean delivery. The authors' primary purpose in this randomized study was to evaluate the effects of epidural analgesia on the rate of cesarean deliveries by providing a suitable alternative: patient-controlled intravenous analgesia. METHODS: Seven hundred fifteen women of mixed parity in spontaneous labor at full term were randomly assigned to receive either epidural analgesia or patient-controlled intravenous meperidine analgesia. Epidural analgesia was maintained with a continuous epidural infusion of 0.125% bupivacaine with 2 microg/ml fentanyl. Patient-controlled analgesia was maintained with 10-15 mg meperidine given every 10 min as needed using a patient-controlled pump. Procedures recorded in a manual that prescribed the intrapartum management were followed for each woman randomized in the study. RESULTS: A total of 358 women were randomized to receive epidural analgesia, and 243 (68%) of these women complied with the epidural analgesia protocol. Similarly, 357 women were randomized to receive patient-controlled intravenous meperidine analgesia, and 259 (73%) of these women complied with the patient-controlled intravenous analgesia protocol. Only five women who were randomized and received patient-controlled intravenous meperidine analgesia according to the protocol crossed over to epidural analgesia due to inadequate pain relief. There was no difference in the rate of cesarean deliveries between the two analgesia groups using intention-to-treat analysis based on the original randomization (epidural analgesia, 4% [95% CI: 1.9-6.2%] compared with patient-controlled intravenous analgesia, 5% [95% CI: 2.6-7.2%]). Similar results were observed for the analysis of the protocol-compliant groups (epidural analgesia, 5% [95% CI: 2.6-8.5%] compared with patient-controlled intravenous analgesia, 6% [95% CI: 3-8.9%]). Women who received epidural analgesia reported lower pain scores during labor and delivery compared with women who received patient-controlled intravenous analgesia. CONCLUSIONS: Epidural analgesia was not associated with increased numbers of cesarean delivery when compared with a suitable alternative method of analgesia.

Adult↗
PubMed1998

Physostigmine prevents postanesthetic shivering as does meperidine or clonidine.

BACKGROUND: Postanesthetic shivering develops in as many as one half of patients recovering from isoflurane anesthesia. Cholinergic stimulation of the hypothalamic-pituitary-adrenal axis and adrenal medulla by physostigmine enhances secretion of arginine vasopressin, epinephrine, and norepinephrine. Because the hypothalamus is the dominant thermoregulatory controller in mammals, and these neurotransmitters may be involved in body temperature control, physostigmine administration may influence the incidence of shivering. Accordingly, the authors tested the hypothesis that physostigmine administration inhibits postanesthetic shivering. Its efficacy was compared with that of saline (negative control) and meperidine and clonidine (positive controls). METHODS: Sixty patients having surgery of the ear or nose were tested. General anesthesia was induced with 2 mg/kg propofol, 0.1 mg/kg vecuronium, and 1.5 microg/kg fentanyl and maintained with isoflurane (1.5 +/- 0.4%) in 70% nitrous oxide. At the end of surgery, the patients were randomly assigned to receive an intravenous bolus of 0.04 mg/kg physostigmine, isotonic saline, 0.5 mg/kg meperidine, or 1.5 microg/kg clonidine. Heart rate, mean arterial blood pressure, oxygen saturation, visual analog pain score, temperature, and postanesthetic shivering were measured during recovery. RESULTS: Postanesthetic shivering occurred in 6 of 15 (40%) patients given saline. In contrast, postanesthetic shivering was significantly reduced in physostigmine-treated patients (1 of 15, or 7%) and was absent in patients given clonidine or meperidine. CONCLUSIONS: Physostigmine inhibited shivering as well as did two established treatments, meperidine and clonidine. These data suggest that cholinergic systems contribute to the genesis and control of postanesthetic shivering.

Adult↗
PubMed2005

Intravenous butorphanol, meperidine, and their combination relieve pain and distress in women in labor.

BACKGROUND: Systemic opioids are commonly administered during labor, but their efficacy has been recently questioned. In addition, laboratory and clinical studies provide a strong rationale for combining mu- and kappa-opioid receptor agonists for analgesia. The authors therefore studied, using validated intensity and affective scales and definitions of effective pain relief, the efficacy of intravenous meperidine, butorphanol, and their combination for labor analgesia. METHODS: Healthy women with singleton term pregnancy requesting analgesia during active labor were studied. Women were randomly assigned to receive 50 mg meperidine, 1 mg butorphanol, or 25 mg meperidine plus 0.5 mg butorphanol (n = 15/group). Pain intensity was assessed using a 0-10 numerical rating scale, and affective magnitude was assessed using a ratiometric descriptive scale before drug administration and between the sixth and seventh uterine contractions after drug administration. RESULTS: All three treatments reduced pain intensity equally. Butorphanol alone did not reduce pain affective magnitude, whereas the other treatments did. There was a significant correlation between reduction in pain intensity and affective magnitude in all groups, with greater reductions in affective magnitude than intensity. Overall, 29% of women exhibited clinically meaningful pain relief, with no difference among groups. Groups did not differ in incidence of opioid-induced adverse effects. CONCLUSIONS: These doses of meperidine and butorphanol do reduce pain intensity and affective magnitude, although a minority of patients achieve meaningful pain relief as defined in multiple patient populations, including laboring women. Combination of these drugs did not improve their therapeutic benefit.

Adult↗
PubMed1993

Efficacy of diazepam and meperidine in ambulatory pediatric patients undergoing endoscopy: a randomized, double-blind trial.

Medications are routinely administered to children prior to upper gastrointestinal endoscopy procedures. We evaluated the efficacy and safety of four dosage regimens: meperidine 2 mg/kg (M); low-dose meperidine 1 mg/kg and diazepam 0.1 mg/kg (M low+D); high-dose meperidine 2 mg/kg and diazepam 0.1 mg/kg (M high+D); and, diazepam 0.1 mg/kg (D) in a randomized, double-blind trial in 71 pediatric patients (ages 1 to 19 years). Cooperation, emotional state, and sedation were rated. The frequency of negative behavior demonstration (i.e., crying, gagging, flailing, nervous behavior) indicating ineffective or inadequate sedation was recorded before, during, and after the procedure. Vital signs and oxygen saturation were noted. Significant differences were observed in the efficacy of the various sedation regimens. Overall, the physicians and nurses rated M most effective in children < 11 years. In these children, M high + D and D were rated least effective by the nurses, whereas physicians felt that D was least effective. In the older children, M, M low + D, and M high + D were rated similarly effective by physicians and nurses, and D was rated least effective. In both age groups, the lowest incidence of negative behaviors during the endoscopy procedure occurred in patients who received M. Combinations of D and M + D resulted in an increased incidence of negative behaviors; thus, M may be the preferred sedation regimen in children undergoing endoscopy. The addition of diazepam to meperidine may be detrimental in terms of eliciting negative behaviors.

Adult↗