The effect of premedication on the cognitive functions of the patients undergoing ERCP (Endoscopic Retrograde CholangioPancreatography)

This study aimed to find out the effect of premedication on the cognitive functions of the patients undergoing ERCP (endoscopic retrograde cholangiopancreatography).Patients to be given sedation/analgesia during ERCP was given midazolam 0,15 mg/kg, tramadol 1 mg/kg orally 30 minutes before sedation as premedication. Remifentanil 1 ?g/kg bolus and remifentanil 0,2 ?g/kg/mn infusion was given for sedation. Sedative and analgesic effects of oral midazolam and tramadol premedication and their effects on cognitive functions, respiratory and hemodynamic effects of sedation applied during ERCP, and their possible positive or negative effects during and after operation were compared in patients to have ERCP.This study involved patients of both sexes between 18 and 70 years of age and with ASA physical status I, II, and III who were chosen randomly after taking their informed consent. 40 patients included in the study were followed for HR, MAP, SpO2, MMT, mRSS, BİS, NRS, adverse effects, duration of the operation, patient and physician satisfaction, and the amount of the medicine used before and after premedication, during procedure, and until discharged from recovery unit.In conclusion, tramadol is less successful in sedation than midazolam and not adequate in the prevention of agitation. In general, midazolam provides better sedation than tramadol. Midazolam creates hemodynamic changes within normal clinical limits in proportion to the active sedation it forms. Tramadol is less successful than midazolam in preventing the increase of the heart rate as a result of sympathetic activity increase after inadequate sedation and of spasmolytic use. Midazolam and tramadol do not affect respiratory functions negatively but midazolam and remifentanil use in combination has more effect on respiratory functions. BIS is also useful in the monitorization of sedation for out-patients and is in correlation with mRSS. BİS and mRSS correlation is stronger in midazolam. As midazolam provides better sedation, it is more reliable for adverse effects. Although there was a minimal distortion in recall function during the first hour in post operative period due to the amnesic effect of midazolam, any negative effects on cognitive functions were not seen in either groups.Key Words: Premedication, ERCP, sedation, cognitive functions.