Oral Lorazepam is not Superior to Placebo for Lowering Stress in Children Before Digestive Endoscopy: A Double-Blind, Randomized, Controlled Trial

Nurse-led Preoperative Education With Home-based Internet Resources for Pediatric Patients and Their Parents

The majority of pediatric patients and their parents experience fear and anxiety related to their surgical experience. Traditionally, anesthesia providers addressed this anxiety with pharmacologic therapy, such as benzodiazepines, to provide amnesia and anxiolysis. However, this approach has been questioned due to the potential for developmental neurotoxicity, among other drawbacks. Further, the pharmacological approach does not remove preexisting anxiety that the child and parent experience before arrival and during check-in. Pediatric and parental preparation before surgery is an important step that continues to be inconsistently addressed, particularly in lower-resource community hospitals where the majority of routine pediatric outpatient procedures occur. This care gap provides an opportunity for preanesthesia nurses to intervene with valid, evidence-based preoperative education tools aimed at pediatric patients and their parents. Providing these resources before the day of surgery allows time for child-directed, at-home practice as often as the parent(s) and patient choose. Use of available resources from a leading children's hospital, nurses can create a tailored, developmentally appropriate preoperative education plan for pediatric patients and their parents, providing families with the power to create a positive surgical experience.

The Evolution of Sedation for Pediatric Gastrointestinal Endoscopy

Sedation for pediatric endoscopy has evolved from an endoscopist-administered component of procedures to an almost entirely anesthesiologist-supported endeavor. Nevertheless, there are no ideal endoscopist or anesthesiologist-administered sedation protocols, and wide practice variation exists in both models. Furthermore, sedation for pediatric endoscopy, whether administered by endoscopists or anesthesiologists, remains the highest risk to patient safety. This underscores the importance of both specialties identifying best sedation practices together that can safeguard patients while maximizing procedural efficiency and minimizing costs. In this review, the authors discuss specific levels of sedation for endoscopy and the risks and benefits of various regimens.

Evaluation of the sedative effect of sublingual lorazepam versus placebo in patients underwent endoscopy: a double-blind, randomized controlled clinical trial

Background

Digestive endoscopy (DE) is uncomfortable for most patients. Lorazepam is a potent benzodiazepine with anxiolytic and sedative effects.

Objective

This study aims to determine the sedative effect of sublingual lorazepam versus placebo as a premedication in patients who underwent DE.

Design

This is a mono-center, double-blind, and randomized controlled trial.

Methods

A lorazepam sublingual tablet was made by researchers and physical tests were done on it, then the double-blind placebo-controlled trial was done to investigate the efficacy of 2 mg sublingually administered lorazepam as a premedication for endoscopy. Lorazepam or a placebo tablet was administered sublingually 30 min before the endoscopy. The patients, nurses, and physicians were blinded to the patient group. The depth of sedation was evaluated according to the American Society of Anesthesiology.

Results

In all, 116 patients were randomly assigned to take either lorazepam (n = 58) or a placebo (n = 58). The results of physical properties tests were acceptable according to United States Pharmacopeia. There were no statistical differences between groups regarding age and gender. In the lorazepam group, 75.8% of patients showed mild sedation, and 24.2% of patients showed no sedation. All of the patients in the placebo had no sedation (p = 0.001). Time of procedure (p < 0.001), intraoperative O2 saturation (p < 0.001), intraoperative heart rate (p < 0.001), and intraoperative blood pressure (p < 0.001) were significantly lower in the lorazepam group. No significant or dangerous side effects were observed except a bit of giddiness and dizziness.

Conclusion

The results of this study showed that prescription of sublingual lorazepam 25-30 min before endoscopy provided mild sedation.

Registration

IRCT201611039014N130 (05/11/2016); https://en.irct.ir/trial/9568.