Non-invasive monitoring of intracranial pressure during midazolam-induced moderate sedation for upper gastrointestinal endoscopy / Monitoramento não invasivo da pressão intracraniana durante a sedação moderada induzida por midazolam para endoscopia digestiva alta

Bianca Drewnowsk, Rafael Nastas Acras, Cristiane Rickli, Mariana Schechtel Koch, Bruna França Bueno, Robson Schimandeiro Novak, José Carlos Rebuglio Vellosa


Midazolam is a drug chosen for moderate sedation by many endoscopists, it acts on receptors of the cortex, thalamus and cerebellum to produce the sedation effect, and its effects on intracranial pressure during moderate sedation have been poorly studied. This report provided data on intracranial pressure monitoring before, during sedation application, during upper digestive endoscopy and after examination. From this collected data we evaluated intracranial pressure through its wave morphology and P2/P1 ratio. A small reduction in this last parameter was observed after the exam and may be related to midazolam use. It is suggested this must be investigated in further studies.



Midazolam, Moderate Sedation, Intracranial Pressure, Brain Compliance, Non-Invasive Monitoring.


Abdalla, M. (2018). Pharmacology of Non-opioid Intravenous Anesthetics. In: Farag, E., Tetzlaff, J. E., Argalious, M. & Sharma, D. (Eds.), Basic Sciences in Anesthesia (pp. 109-121). Cham: Springer.

Ballestero, M. F. M., Frigieri, G., Cabella, B. C. T., Oliveira, S. M., & Oliveira, R. S. (2017). Prediction of intracranial hypertension through noninvasive intracranial pressure waveform analysis in pediatric hydrocephalus. Child's Nervous System, 33(9), 1517-1524.

Bueno, B.; Barbosa, C.R.; Borato, D.C.K.; Vellosa, J.C.R. (2021). Elderly Non Invasive Intracranial Pressure Monitorization: A Report Of Wave Morphology And Cerebral Compliance. Brazilian Journal of Development, 7(1), 6952-6960.

Frigieri, G., Andrade, R. A. P., Dias, C., Spavieri, D. L. Jr., Brunelli, R., Cardim, D. A., ... Mascarenhas, S. (2018). Analysis of a Non-invasive Intracranial Pressure Monitoring Method in Patients with Traumatic Brain Injury. In T. Heldt (Ed.), Intracranial Pressure & Neuromonitoring XVI (pp. 107-110). Cambridge, MA: Springer.

Harary, M., Dolmans, R. G. F., & Gormley, W. B. (2018). Intracranial Pressure Monitoring-Review and Avenues for Development. Sensors, 18(2), 465-480.

Kim, E. H., Park, J. C., Shin, S. K., Lee, Y. C., & Lee S. K. (2018). Effect of the midazolam added with propofol-based sedation in esophagogastroduodenoscopy: A randomized trial. Journal of Gastroenterology and Hepatology, 33(4), 894-899.

Kim, J. H., Kim, D. H., & Kim, J. H. (2019). Low-dose midazolam and propofol use for conscious sedation during diagnostic endoscopy. The Kaohsiung Journal of Medical Sciences, 35(3), 160-167.

Lauriola, M., Tomai, M., Palma, R., Spina, G. L., Foglia, A., Panetta, C., ... Pontone, S. (2019). Intolerance of Uncertainty and Anxiety-Related Dispositions Predict Pain During Upper Endoscopy. Frontiers in Psychology, 10(1112), 1-13.

Oertel, J., Antes, S. (2018). Intracranial Pressure Monitoring: Indications, Techniques, Interpretation. Pediatric Hydrocephalus, 1195-1220.

Pessoa, R. R. P., Ferreira, D. P. P., Viana, D. P. & Alencar, L. P. (2018). Orientações pré e pós-exame endoscópico [Pre and post endoscopic examination guidelines]. In: Averbach, M., Ferrari, A. P., Jr., Segal, F., Ejima, F. H., Paulo, G. A., Fang, H. L., ..., Dib, R. A. (Eds.), Tratado Ilustrado de Endoscopia Digestiva [Illustrated Treaty of Digestive Endoscopy] (1st ed.). Rio de Janeiro: Thieme Revinter.

Rickli, C.; Koch, M.S.; Bueno, B.F.; Vellosa, J.C.R. (2021). Efeito da Hemodiálise na Complacência Cerebral avaliada de forma Não Invasiva: Relato de Caso. Brazilian Journal of Development, 7(1), 10169-10177.

Shteamer, J. W., & Dedhia, R. C. (2017). Sedative choice in drug‐induced sleep endoscopy: A neuropharmacology‐based review. Laryngoscope, 127(1), 273-279.

Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E. Jr., Collins, K. J., Himmelfarb, D. C., … Wright, J. T. Jr. (2018). ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension, 71, 13-115.

Yu, D., Zhu, Y., Cui, C., Long, R., & Ma, J. (2019). Midazolam prevents sevoflurane-induced death in hippocampal neurons. Tissue and Cell, 58, 1-7.



  • There are currently no refbacks.