Etomidate vs. Midazolam for Sedation During ERCP

Study Overview
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Brief Summary
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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
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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.

Official Title
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Etomidate With Meperidine vs Midazolam With Meperidine for Sedation During Endodscopic Retrograde Cholangiopancreatogram (ERCP)

Conditions
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Choledocholithiasis, Cholangiocarcinoma, Pancreatitis, Pancreatic Cancer

Intervention / Treatment
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* Drug: Etomidate
* Drug: Midazolam
* Drug: Meperidine


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients who are scheduled diagnositic or therapeutic ERCP. Age : more than 20 and less than 90 years old ASA(American Society of Anesthesiologists) classificiation : I, II, III Exclusion Criteria:Patients following Refuse to be enrolled ASA American Society of Anesthesiologists)classification IV, V Breast feeder The mentally ill Drug abuser Hypersensitivity to sedative or opioids Alcohol intoxication or dependency Body mass index (BMI) 36kg/m2 or more Unstable vital sign tachypnea, respiration rate more than 25/min or less than 10/min Oxygen saturation : 90% or less Systolic blood pressure : less than 90 mmHg or more than 180 mmHg Diastolic blood pressure : less than 50 mmHg or more than 100 mmHg Heart rate : more than 120 beat/min or less than 50 beat/min.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Etomidate<br>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. | Drug: Etomidate<br>* 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.<br>* Other names: Etomidate lipro IV;Drug: Meperidine<br>* Both groups were administered same dose of meperidinie 50mg. Then elders > 80 years old were administered 25mg iv bolus.<br>* Other names: Pethidine;|
| Experimental: Midazolam<br>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%. | Drug: Midazolam<br>* 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%.<br>Drug: Meperidine<br>* Both groups were administered same dose of meperidinie 50mg. Then elders > 80 years old were administered 25mg iv bolus.<br>* Other names: Pethidine;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Intervention | The frequency of intervention which was defined as any restraint of the patient's head, arms, or legs if they became agitated, or if patient movement was not controlled with verbal instruction from the endoscopist during the whole intraoperative phases. | Throughout the whole ERCP procedure | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Event of Hypoxia | Hypoxia defined as peripheral blood oxygen saturation measured by pulse oxymeter < 90% | Every 5min in Preoperative, intraoperative phase and 15 min in Recovery phase | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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midazolam, Endoscopic Retrograde Cholangiopancreatography (ERCP), Conscious Sedation, etomidate