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- W2978703722 abstract "Introduction: Intravenous (IV) midazolam is widely used for sedation during brief medical procedures. CYP3A4 enzyme inhibiting medications are commonly prescribed (Table 1). Existing literature indicates there is concern for potential excessive sedation and respiratory compromise if midazolam is administered to individuals taking concurrent CYP3A4 enzyme inhibiting medications. The aim of this study was to evaluate the safety of receiving moderate sedation with IV midazolam during endoscopic procedures for patients taking CYP3A4 inhibitors.Table 1: Commonly Prescribed CYP3A4 Enzyme Inhibiting MedicationsMethods: A retrospective electronic query within the EHR was performed between October 2011-December 2014. All adult patients (≥18 years) who had an outpatient endoscopic procedure and received at least one dose of IV midazolam intra-operatively were included. Outcome measures included intra-operative vital signs, maximum oxygen requirement, nadir level of consciousness, and post-procedure recovery time. Propensity score matched analysis was performed comparing patients receiving CYP3A4 inhibitor (cases) versus not (controls). Equivalence testing was performed using two one-sided test procedures with appropriate equivalence margins. Results: A total of 2,392 patients underwent an outpatient endoscopic procedure with administration of IV midazolam. 1,334 patients (55.8% of total patients) were actively prescribed CYP3A4 inhibitors and univariate analysis revealed significant differences in age, sex, and midazolam dosing. Subsequent propensity matching yielded 927 matched pairs. There was equivalence between cases and controls that was demonstrated by non-significant associations: intra-procedural vital signs [nadir systolic blood pressure (115.1 vs. 115. 2 mmHg, p = 0.90); maximum heart rate (83.5 vs. 82.9, p = 0.43); maximum respiratory rate (29.7 vs. 30.2, p = 0.39)], maximum oxygen requirement (7.0% vs. 8.5% with > 2 liter requirement, p = 0.22), and nadir level of consciousness (51.6% vs. 51.4% with score > 1, p = 0.89). Furthermore, there was no difference in post-procedure recovery time (70.9 vs. 70.5 minutes, p = 0.84). Conclusion: This equivalence study demonstated that IV midazolam can be administered safely during outpatient endoscopic procedures in patients taking CYP 3A4 inhibiting medications." @default.
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- W2978703722 date "2016-10-01" @default.
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- W2978703722 title "Intravenous Midazolam Is Safe During Outpatient Endoscopic Procedures Regardless of Concurrent Enzyme-Inhibiting Medications: A Propensity Matched Equivalence Study" @default.
- W2978703722 doi "https://doi.org/10.14309/00000434-201610001-00313" @default.
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