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©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Sep 7, 2008; 14(33): 5197-5203
Published online Sep 7, 2008. doi: 10.3748/wjg.14.5197
Maintenance time of sedative effects after an intravenous infusion of diazepam: A guide for endoscopy using diazepam
Mitsushige Sugimoto, Takahisa Furuta, Akiko Nakamura, Naohito Shirai, Mutsuhiro Ikuma, Shingen Misaka, Shinya Uchida, Hiroshi Watanabe, Kyoichi Ohashi, Takashi Ishizaki, Akira Hishida
Mitsushige Sugimoto, Akiko Nakamura, Mutsuhiro Ikuma, Akira Hishida, First Department of Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan
Takahisa Furuta, Center for Clinical Research, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan
Naohito Shirai, Department of Gastroenterology, Enshu General Hospital, 1-1-1 Tyuou, Naka-ku, Hamamatsu 430-0929, Japan
Shingen Misaka, Shinya Uchida, Department of Pharmacoki-netics and Pharmacodynamics, School of Pharmaceutics Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan
Hiroshi Watanabe, Takashi Ishizaki, Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu 431-3192, Japan
Kyoichi Ohashi, Department of Clinical Pharmacology and Therapeutics, Oita University, 1-1 Idaigaoka, Hazama, Yufu 879-5593, Japan
Author contributions: Sugimoto M, Furuta T, Nakamura A and Shirai N designed research; Sugimoto M, Furuta T, Nakamura A, Shirai N, Misaka S and Uchida S performed research; Sugimoto M, Furuta T, Nakamura A, Shirai N, Ikuma M, Misaka S, Uchida S, Watanabe H, Ohashi K, Hishida A and Ishizaki T analyzed data and wrote the paper.
Supported by Grants-in-Aid for Scientific Research from YOKOYAMA Foundation for Clinical Pharmacology and a Grant-in-Aid from the Center of Excellence (COE) from the Ministry of Education, Culture, Sports, Science and Technology of Japan, and Grant-in-Aid from the Ministry of Education, Culture, Sports, Science and Technology of Japan No. 17590470
Correspondence to: Dr. Mitsushige Sugimoto, First Department of Medicine, Hamamatsu University School of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Rm 3A-320B, Houston, Texas 77030, United States. sugimoto@bcm.edu
Telephone: +1-713-7947280 Fax: 1+713-7954471
Received: May 23, 2008
Revised: June 30, 2008
Accepted: July 7, 2008
Published online: September 7, 2008
AIM: To examine whether the sedative effects assessed by psychomotor tests would depend on the cytochrome P450 (CYP) 2C19 genotypes after an infusion regimen of diazepam commonly used for gastrointestinal endoscopy in Japan.
METHODS: Fifteen healthy Japanese volunteers consisting of three different CYP2C19 genotype groups underwent a critical flicker fusion test, an eye movement analysis and a postural sway test as a test for physical sedative effects, and a visual analog scale (VAS) symptom assessment method as a test for mental sedative effects during the 336 h period after the intravenous infusion of diazepam (5 mg).
RESULTS: The physical sedative effects assessed by the critical flicker test continued for 1 h (t values of 5 min, 30 min and 60 min later: 4.35, 5.00 and 3.19, respectively) and those by the moving radial area of a postural sway test continued for 3 h (t values of 5 h, 30 h, 60 min and 3 h later: -4.05, -3.42, -2.17 and -2.58, respectively), which changed significantly compared with the baseline level before infusion (P < 0.05). On the other hand, the mental sedative effects by the VAS method improved within 1 h. The CYP2C19 genotype-dependent differences in the postinfusion sedative effects were not observed in any of the four psychomotor function tests.
CONCLUSION: With the psychomotor tests, the objective sedative effects of diazepam continued for 1 h to 3 h irrespective of CYP2C19 genotype status and the subjective sedative symptoms improved within 1 h. Up to 3 h of clinical care appears to be required after the infusion of diazepam, although patients feel subjectively improved.
