Old Is (Not) Gold: Midazolam Monotherapy versus Midazolam Plus Fentanyl for Sedation during Cardiac Catheterization
Objective. We aimed to study the differences in perception of pain during cardiac catheterization with midazolam monotherapy compared to the current standard of midazolam plus fentanyl. Background. Procedural sedation is important to ensure comfort and safety in patients undergoing left heart cathet...
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Wiley
2021-01-01
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| Series: | Journal of Interventional Cardiology |
| Online Access: | http://dx.doi.org/10.1155/2021/9932171 |
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| author | William Black Raj Baljepally Laylan Shali Omar Alsharif Scott Warden Eric Heidel Xiaopeng Zhao |
| author_facet | William Black Raj Baljepally Laylan Shali Omar Alsharif Scott Warden Eric Heidel Xiaopeng Zhao |
| author_sort | William Black |
| collection | DOAJ |
| description | Objective. We aimed to study the differences in perception of pain during cardiac catheterization with midazolam monotherapy compared to the current standard of midazolam plus fentanyl. Background. Procedural sedation is important to ensure comfort and safety in patients undergoing left heart catheterization. Despite the widespread use of midazolam and fentanyl for procedural sedation, the effectiveness of this dual agent approach to sedation has never been studied in comparison to midazolam monotherapy. Methods. A total of 129 patients undergoing sedation for outpatient elective cardiac catheterization were randomly assigned to either midazolam monotherapy (n = 69) or combination of midazolam and fentanyl (n = 60). The primary outcome was assessment of pain perception prior to discharge by patient completion of a pain questionnaire. Participants were asked if they experienced any pain during their procedure (yes/no) and, if yes, asked to rate their overall pain level using a 10-point Likert scale that ranged from 1 (minimal pain) to 10 (worst pain imaginable). Results. Most patients (n = 94, 73%) reported no pain during their procedure. Patients sedated with midazolam monotherapy reported similar average pain scores compared to patients sedated with the combination of midazolam and fentanyl (1.1 vs. 1.1, p=0.95). Conclusions. Among patients undergoing elective cardiac catheterization, no significant differences in pain scores were noted between sedation with midazolam alone compared to midazolam and fentanyl. Due to fentanyl’s unfavorable interaction with P2Y12 agents, increased costs, and addiction potential, it is imperative that cardiologists revisit the role of effective procedural sedation with a single agent and avoid the use of fentanyl. |
| format | Article |
| id | doaj-art-eee4dbcde73d4f6f9496ad1583293bbb |
| institution | DOAJ |
| issn | 0896-4327 1540-8183 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Interventional Cardiology |
| spelling | doaj-art-eee4dbcde73d4f6f9496ad1583293bbb2025-08-20T03:21:15ZengWileyJournal of Interventional Cardiology0896-43271540-81832021-01-01202110.1155/2021/99321719932171Old Is (Not) Gold: Midazolam Monotherapy versus Midazolam Plus Fentanyl for Sedation during Cardiac CatheterizationWilliam Black0Raj Baljepally1Laylan Shali2Omar Alsharif3Scott Warden4Eric Heidel5Xiaopeng Zhao6University of Tennessee Medical Center, Heart Lung Vascular Institute, Department of Cardiology, Knoxville, TN, USAUniversity of Tennessee Medical Center, Heart Lung Vascular Institute, Department of Cardiology, Knoxville, TN, USAUniversity of Tennessee Medical Center, Heart Lung Vascular Institute, Department of Cardiology, Knoxville, TN, USAUniversity of Tennessee Medical Center, Heart Lung Vascular Institute, Department of Cardiology, Knoxville, TN, USAUniversity of Tennessee Medical Center, Heart Lung Vascular Institute, Department of Cardiology, Knoxville, TN, USAUniversity of Tennessee Medical Center, Heart Lung Vascular Institute, Department of Cardiology, Knoxville, TN, USADepartment of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, TN, USAObjective. We aimed to study the differences in perception of pain during cardiac catheterization with midazolam monotherapy compared to the current standard of midazolam plus fentanyl. Background. Procedural sedation is important to ensure comfort and safety in patients undergoing left heart catheterization. Despite the widespread use of midazolam and fentanyl for procedural sedation, the effectiveness of this dual agent approach to sedation has never been studied in comparison to midazolam monotherapy. Methods. A total of 129 patients undergoing sedation for outpatient elective cardiac catheterization were randomly assigned to either midazolam monotherapy (n = 69) or combination of midazolam and fentanyl (n = 60). The primary outcome was assessment of pain perception prior to discharge by patient completion of a pain questionnaire. Participants were asked if they experienced any pain during their procedure (yes/no) and, if yes, asked to rate their overall pain level using a 10-point Likert scale that ranged from 1 (minimal pain) to 10 (worst pain imaginable). Results. Most patients (n = 94, 73%) reported no pain during their procedure. Patients sedated with midazolam monotherapy reported similar average pain scores compared to patients sedated with the combination of midazolam and fentanyl (1.1 vs. 1.1, p=0.95). Conclusions. Among patients undergoing elective cardiac catheterization, no significant differences in pain scores were noted between sedation with midazolam alone compared to midazolam and fentanyl. Due to fentanyl’s unfavorable interaction with P2Y12 agents, increased costs, and addiction potential, it is imperative that cardiologists revisit the role of effective procedural sedation with a single agent and avoid the use of fentanyl.http://dx.doi.org/10.1155/2021/9932171 |
| spellingShingle | William Black Raj Baljepally Laylan Shali Omar Alsharif Scott Warden Eric Heidel Xiaopeng Zhao Old Is (Not) Gold: Midazolam Monotherapy versus Midazolam Plus Fentanyl for Sedation during Cardiac Catheterization Journal of Interventional Cardiology |
| title | Old Is (Not) Gold: Midazolam Monotherapy versus Midazolam Plus Fentanyl for Sedation during Cardiac Catheterization |
| title_full | Old Is (Not) Gold: Midazolam Monotherapy versus Midazolam Plus Fentanyl for Sedation during Cardiac Catheterization |
| title_fullStr | Old Is (Not) Gold: Midazolam Monotherapy versus Midazolam Plus Fentanyl for Sedation during Cardiac Catheterization |
| title_full_unstemmed | Old Is (Not) Gold: Midazolam Monotherapy versus Midazolam Plus Fentanyl for Sedation during Cardiac Catheterization |
| title_short | Old Is (Not) Gold: Midazolam Monotherapy versus Midazolam Plus Fentanyl for Sedation during Cardiac Catheterization |
| title_sort | old is not gold midazolam monotherapy versus midazolam plus fentanyl for sedation during cardiac catheterization |
| url | http://dx.doi.org/10.1155/2021/9932171 |
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