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Kidney Week

Abstract: PO1358

Use of Diphenhydramine as Adjuvant to Conscious Sedation in Patients Undergoing Interventional Nephrology Procedures

Session Information

  • Vascular Access
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Patel, Ravi V., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Alagusundaramoorthy, Sayee Sundar, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Karim, Muhammad Sohaib, University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Chan, Micah R., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Astor, Brad C., University of Wisconsin-Madison, Madison, Wisconsin, United States
  • Gardezi, Ali I., University of Wisconsin-Madison, Madison, Wisconsin, United States
Background

Benzodiazepine and opioids are commonly used for conscious sedation during interventional nephrology procedures but are associated with adverse events such as bradycardia and respiratory depression. We are proposing to use Diphenhydramine as adjuvant medication to decrease the required dose of benzodiazepine and opioid.

Methods

We compared patients who received conscious sedation with IV midazolam and IV fentanyl as per standard practices to patients who received IV diphenhydramine prior to receiving IV midazolam and IV fentanyl. Level of sedation was managed as per guidelines of moderate sedations. Data collected included baseline patient characteristics, dose of midazolam and fentanyl used, duration of the procedure, type of the procedure and incidence of bradycardia and hypoxia during procedure. We also looked at if sedation was administered by physician vs nurse.

Results

Out of total 407 patients included in the study, 225 patient received Diphenhydramine as adjuvant to conscious sedation. Diphenhydramine use significantly reduced midazolam (2.2 mg vs 2.88 mg, p valuve <0.001) and fentanyl (88.2 mcg vs 102.07 mcg p value 0.005) dose requirements during procedures. It was not associated with increased rates of bradycardia and hypoxia. When comparing who administered sedation, physician administered sedation was associated with lower midazolam (2.18 mg vs 3.37 mg, p value < 0.001) and fentanyl (99.29 mcg vs 105.97 mcg, p value 0.04) dose without any difference in the rate of side effects, as compare to nurse administered sedation.

Conclusion

Our study indicates that the use of IV diphenhydramine is safe and effective as conscious sedation for patient undergoing Interventional Nephrology procedures and associated with reduction in benzodiazepine and opioid dose requirements.