Etomidate vs. Midazolam for Sedation During ERCP
Condition: Choledocholithiasis; Cholangiocarcinoma; Pancreatitis; Pancreatic Cancer
MeSH terms: Cholangiocarcinoma; Pancreatitis; Choledocholithiasis
Study type: Interventional
Phase: Phase 4

Summary: 
      Recently up-coming drug, etomidate which is a modulator of GABA(gamma-Aminobutyric acid)-A
      receptor has been known that it maintains the appropriate sedative levels and affects little
      effects on respiratory system.

      The investigators are now trying to investigate that etomidate with meperidine combination
      regimen is superior to the midazolam with meperidine more effective and less harm on sedation
      during the ERCP procedure.
    

Detailed description: 
      ERCP (Endoscopic retrograde cholangiopancreatogram) is an uncomfortable and time-consuming
      procedure compared to other endoscopic procedures. Most ERCP procedure had been performed in
      sedation using tranquilizers and pain-killers.

      Until recently, midazolam and opioid combination regimen recognized as a standard therapy is
      widely used, but the sedative effect is insufficient and intermittent paradoxical reaction
      has been questioned. Another drug, such as propofol, has been known that the sedative effect
      is superior one of the midazolam but disappointed due to narrow therapeutic range of
      respiratory distress and absence of antagonist. Meanwhile, recently up-coming drug, etomidate
      which is a modulator of GABA-A receptor has been known that it maintains the appropriate
      sedative levels and affects little effects on respiratory system.

      For these advantages, this short acting sedative drug has been widely used in the emergency
      room during minor operation and in the operation room for induction. However, research on the
      efficacy during ERCP was not yet published.

      In this regards, the purpose of the investigators study is to prove the efficacy of etomidate
      for sedation and to establish new evidence based sedation guidelines during ERCP procedure.
    

Intervention name(s): Etomidate; Midazolam; Meperidine
Intervention type(s): Drug; Drug; Drug
Intervention description(s): This cohort would be administered etomidate with meperidine. The initial dose of etomidate is 0.1mg/kg IV and meperidine, 25mg. Additional dose of etomidate is 2mg(1cc). In old age cased, more than 65 years old, 30% of initial dose discounted.; This cohort would be administered midazolam with meperidine. The initial dose of midazolam is 0.06mg/kg IV and meperidine 50mg IV. Additional dose is 1mg of midazolam. In the elders, more than 65 years old, initial dose was declined to 70%.; Both groups were administered same dose of meperidinie 50mg. Then elders > 80 years old were administered 25mg iv bolus.
Other intervention name(s): Etomidate lipro IV; Pethidine
Intervention MeSH terms: Midazolam; Meperidine; Etomidate
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Endoscopic Retrograde Cholangiopancreatography (ERCP); Conscious Sedation; etomidate; midazolam