***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study compares the effects of two different benzodiazepines used for conscious sedation during combined upper gastrointestinal endoscopy ( EGD ) and colonoscopy . Subjects were assessed for their degree of analgesia and amnesia for the procedure , prior experience with endoscopy , and willingness to undergo another similar procedure should such be necessary . The patients were r and omized single blind to receive either midazolam or diazepam for their preprocedure sedation . The amount of preprocedure sedation utilized was determined by titration of the dose to achieve slurring of speech . Prior to receiving either agent , the subjects were shown a st and ard card containing pictures of 10 common objects , were asked to name and remember them , and were told they would be “ quizzed ” ( at 30 min and 24 hr ) after being se date d for their re collection as to the objects pictured on the card . Each subject filled out a question naire addressing their perceived discomfort during the endoscopic procedure and their memory of the procedure 24 hr after the procedure . Sixty-three percent of the midazolam-se date d subjects reported total amnesia for their colonoscopy vs 20 % of diazepam-se date d patients ( P<0.001 ) . Fifty-three percent of midazolam-se date d patients reported total amnesia of their upper gastrointestinal endoscopy vs only 23 % of diazepam-se date d subjects ( P<0.05 ) . The midazolam-se date d subjects reported experiencing less pain with both upper gastrointestinal endoscopy ( P<0.05 ) and colonoscopy ( P<0.001 ) than did the diazepam-se date d group . Most importantly , the midazolam group was more willing to undergo another similar endoscopic procedure should they be asked to do so by their physician ( P<0.05 ) . Subjects greater than 60 years of age required significantly less  midazolam for sedation than did the younger subjects ( P<0.001 ) . This difference in dosing based upon age was not observed in the diazepam-se date d group . Based upon these data we conclude that midazolam is superior to diazepam in producing conscious sedation for combined upper gastrointestinal endoscopy and colonoscopy with regard to : ( 1 ) amnesia for the procedures , ( 2 ) discomfort experienced at the time of the procedure , and ( 3 ) better patient acceptance of future gastrointestinal endoscopic procedures Midazolam is a new imidazobenzodiazepine . It is more potent and has a shorter duration of action than diazepam . Forty patients undergoing upper gastrointestinal endoscopy for the first time were r and omized to receive either diazepam or midazolam as the preendoscopic sedative agent . Both the patient and the endoscopist were blinded regarding the treatment group . Vital signs were monitored before , during , and after induction . Question naires were used to assess patient recall of the procedure , as well as endoscopist and patient satisfaction . Recovery from sedation was assessed using the Treiger test ( i.e. , connecting a series of sequential points with a line ) . Twenty-four hours and 1 to 2 weeks later , follow-up was obtained on all patients to evaluate for any delayed adverse effects . When compared to diazepam , midazolam was more potent and decreased induction time by more than 2.5 min ( p less than 0.001 ) . Recovery time and endoscopist and patient satisfaction were similar ( p greater than 0.1 ) , but patient recall was significantly less in the midazolam group ( p less than 0.01 ) . Fewer adverse reactions ( e.g. , thrombophlebitis ) were noted with midazolam ; however , the magnitude of the difference was not statistically significant . Hemodynamic parameters were also similar . It is concluded that midazolam is a safe , effective , and promptly acting sedative for upper gastrointestinal endoscopy . Compared to diazepam it was significantly more potent , faster acting , and associated with greater amnesia OBJECTIVE To compare the cardiorespiratory effects of benzodiazepine and midazolam used for sedation in patients undergoing upper gastrointestinal endoscopy with cardiorespiratory changes in the non-se date d patients . STUDY DESIGN Comparative , r and omized , single blind study . Duration and Setting : Department of Medicine at Government Medical College and Hospital , Ch and igarh , India , from January to July 2000 . PATIENTS AND METHODS A total of 252 adult patients without previous cardiorespiratory co-morbidity , undergoing upper gastrointestinal endoscopy were recruited . They were r and omly allocated in to group I ( placebo with saline administration ) , group II ( diazepam administered ) and group III ( midazolam administered ) . The pulse rate , blood pressure , ECG and peripheral oxygen saturation ( SpO2 ) was noted at baseline , after pre-medication , during endoscopy and postendoscopy . Statistical analysis was done by paired t-test , Chi-square test and ANOVA as applicable . RESULTS There was no difference in baseline record of the three groups . Significant fall in SpO2 was noted in all the groups , more marked in the se date d one during endoscopy . Tachycardia developed in all the three groups and settled within 5 minutes of endoscopy . Blood pressure remained more stable in the se date d group . ECG changes included atrial and ventricular premature contraction in all the three groups . CONCLUSION Endoscopy is a safe procedure where cardiorespiratory complication are minimized in non-se date d patients when appropriately selected OBJECTIVE  Lumbar puncture ( LP ) is usually associated with anxiety and apprehension in children and their parents . This study was performed for controlling children 's anxiety before and during LP and increasing the success of LP due to relaxation of the child following the use of sedative drugs and to compare the efficacy and side effects of oral midazolam and oral chloral hydrate . METHOD This prospect i ve r and omized controlled clinical trial included 160 children aged 2 - 7 years , c and i date s for LP .  They were divided into two r and omized groups of 80 children each : group I received 80 mg/kg oral chloral hydrate and group II received 0.5 mg/kg oral midazolam before LP . RESULTS The results indicated that the mean sedation grade was 3.8 + /- 1.0 in chloral hydrate group and 2.3 + /- 0.9 in midazolam group ( P < 0.001 ) . The mean onset of sedative effect was 30.9 + /- 8.8 min in midazolam group and 16.5 + /- 5.8 min in chloral hydrate group ( P < 0.001 ) . Prolonged sedation was the most common side effect in oral midazolam group ( 94.4 % ) versus 22.2 % in chloral hydrate group . CONCLUSION Based on the level of sedation , side effects , time to onset of sedation and recovery time from sedation , oral chloral hydrate is a better sedative medication than oral midazolam To determine whether midazolam i.m . as premedication for bronchoscopy involves a risk of overall respiratory failure , we compared hydrocodonum ( 15 mg i.m . ) with midazolam ( 5 - 7.5 mg i.m . , weight related ) as premedication in flexible bronchoscopy in two groups of 30 patients . The two groups were comparable . Arterial blood gases were measured before premedication , before bronchoscopy , and 10 and 60 minutes after the procedure . Significant respiratory depression did not occur in either group . Side effects were rare and similar . Confusional states , as reported with midazolam given orally , were not noted . Midazolam administered as reported above is of value as premedication in flexible bronchoscopy The aim of this study was to evaluate the prevalence of hypoxia related to midazolam sedation during upper gastrointestinal endoscopy . This single blind r and omized placebo control clinical trial , carried out on 180 patients who referred to endoscopy clinic at Imam Khomeini Hospital for selective upper gastrointestinal endoscopy from April to July in 2008 . Informed consents obtained from all participants . Patients under 18-years-old , obese , previous history of asthma , COPD and cigarette smoking were excluded .  Arterial hemoglobin saturation controlled by finger probe pulse oximetry . After pharyngeal lidocaine spray , midazolam was administered intravenously in case group and patients in controlled group received placebo . Demographic characteristics and other variables were recorded in a question naire and data analyzed using SPSS software . Gastrointestinal disturbances and epigastric pain were major indications of endoscopies . The most common endoscopic diagnoses were deudonitis , esophagitis or gastroesophagial reflux . No patients had any serious episode of hypoxia and the incidence of mild hypoxia was not significant in both studied group ( p = 0.823 ) . There was no significant difference in arterial oxygen saturation recorded by the three endoscopists ( p = 0.734 ) . Our data showed that optimal dose of sedation had no hypoxia . So that , we recommend sedative endoscopy in patients without risk factors for hypoxia The objective of this prospect i ve , r and omized , and blinded study was to compare the use of chloral hydrate versus oral midazolam sedation in children undergoing echocardiography .  No adverse effects ( nausea , vomiting , paradoxical agitation , or significant deviations from baseline vital signs ) were noted with either medication . No differences were noted in onset of sedation between the 2 groups , however , the time to complete recovery was significantly shorter with midazolam than with chloral hydrate . The children in the chloral hydrate group had a significantly deeper level of sedation and were more likely to receive a more nearly comprehensive echocardiographic evaluation Background Sedation with midazolam facilitates the performance of diagnostic procedures in children , including voiding cystourethrography ( VCUG ) . However , the influence of sedation on voiding and imaging results have not been adequately evaluated . Objective Midazolam and placebo were compared to assess discomfort during VCUG and to evaluate if sedation influenced the outcome of the examination . Material s and methods The study was prospect i ve , r and omised and double-blind , and included 95 children , 48 in the midazolam group ( median age 2.2 years ) and 47 in the placebo group ( median age 3.2 years ) . The evaluation included the child's/parent 's experience of the VCUG , as well as the examination results . Results The children/parents in the midazolam group experienced the VCUG as less distressing compared to those in the placebo group ( P<0.001 ) . Forty-six of 48 children se date d with midazolam could void during the imaging procedure compared to 38 of 47 children given placebo ( NS ) . There was no difference in frequency or grade of vesicoureteric reflux or bladder emptying between the groups . Conclusions When sedation is required to perform VCUG in children , midazolam can be used without negative effect on the outcome of the examination Objective : We aim ed to determine the efficacy of oral midazolam as premedication to improve tolerance of flexible sigmoidoscopy . Methods : Ninety-nine patients were r and omized to receive 7.5 mg of oral midazolam solution mixed with apple juice or placebo ( apple juice ) , 20 min before sigmoidoscopy . Patients ’ anxiety and pain experienced before sedation , before the procedure , and during the procedure were assessed using a 10-cm visual analog scale ( VAS ) by both patients and physicians ( 0 = no pain , anxiety , 10 = severe pain , anxiety ) . Extent of sedation , amnesia , overall tolerance , adequacy of sedation , and willingness to repeat the procedure were assessed , and changes in vital signs and oximetries were recorded . Results : Fifty-one patients received midazolam and 48 patients received placebo .  Patients reported less pain and anxiety ( VAS 2.56 , 1.64 ) compared with placebo ( VAS 4.62 , 4.16 ) during the procedure ( p < 0.005 , p < 0.0005 ) . Physicians observed less pain and anxiety ( VAS 2.19 , 1.52 ) with midazolam than placebo ( VAS 5.00 , 3.97 ) during the procedure ( p < 0.0001 , p < 0.0001 ) . A significantly greater number of patients judged tolerance of the procedure to be “ excellent ” using midazolam ( p < 0.005 ) compared with placebo . A majority of patients in both groups was willing to repeat the procedure if recommended . Two patients in the midazolam group had transient asymptomatic hypotension during sigmoidoscopy , but no patients were observed to have desaturation by oximetry . Conclusions : Oral midazolam significantly reduces anxiety and pain during flexible sigmoidoscopy as assessed by both patients and physicians . Oral midazolam is a safe and effective premedication before flexible sigmoidoscopy in patients who require or prefer sedation 1 . One hundred and two consecutive patients undergoing upper gastrointestinal endoscopy were r and omised to be se date d with either intravenous diazepam ( Diazemuls-Kabi Vitrum ) or intravenous midazolam ( Hypnovel-Roche ) . It was assumed that midazolam was likely to be approximately twice as potent as diazepam on the basis of previous work . 2 . All patients had an ear oximeter attached throughout the procedure to record continuously their level of oxygen 
    Output:
    
We found no high- quality evidence to determine if midazolam , when administered as the sole sedative agent prior to a procedure , produces more or less effective sedation than placebo or other medications .
There is low- quality evidence that intravenous midazolam reduced anxiety when compared with placebo .
There is inconsistent evidence that oral midazolam decreased anxiety during procedures compared with placebo .
Intranasal midazolam did not reduce the risk of incomplete procedures , although anxiolysis and sedation were observed .
There is moderate- quality evidence suggesting that oral midazolam produces less effective sedation than chloral hydrate for completion of procedures for children undergoing non-invasive diagnostic procedures