A202 EFFECT OF A SINGLE DOSE OF LORAZEPAM ON SALIVARY CORTISOL RESPONSE IN CHILDREN UNDERGOING DIGESTIVE ENDOSCOPY: A RANDOMIZED DOUBLE BLINDED STUDY
Bibliographic record
Abstract
Children undergoing digestive endoscopies express a high level of procedural anxiety. We have shown that salivary Cortisol (sCortisol) is a reliable biomarker of stress in children undergoing endoscopy. It was recently suggested that preoperative psychological status can impact procedural comfort. This randomized trial was designed to investigate the impact of an oral benzodiazepine on the levels of sCortisol and pain score during digestive endoscopies under intravenous sedation. The primary aim was to assess the effect of Lorazepam as compared to placebo on the changes of sCortisol between baseline (C1) and one hour after administration (C2). The secondary aims were to assess the percentage of children experiencing procedural pain and procedure duration. Subjects were prospectively randomized in one of the following groups: Group A (oral Lorazepam, 0.5 mg (body weight < 40 kg) or 1 mg (body weight > 40 kg); Group B (placebo). Randomization was done by blocks of 6 and stratification was performed on sex and previous endoscopy experience. Before the procedure, 2 saliva samples (C1 and C2) were taken with cortisol Salivette tubes. A visual anxiety scale (VAS) and the State Trait Anxiety Inventory for Children (STAIC) were completed at baseline. Sedation protocol was done with intravenous administration of Fentanyl and Midazolam +/- Ketamine. Pain assessment was performed by recording the Nurse-Assessed Patient Comfort Score (NAPCOMS) during each procedure. Ninety children were included in the study. In this interim analysis of 44 children (22 females), sCortisol baseline mean (SD) was 75.3 ± 32.4 nmol/L in Group A and 66.7 ± 34.6 nmol/L in Group B (p=0.47). For children having a colonoscopy, there was a decrease in sCortisol in the Lorazepam arm whereas it increased in the placebo arm. The mean (min-max) change in sCortisol between C1 and C2 was -4.8 (-43.8; + 94.5) nmol/L in Group A and +31.4 nmol/L (-35.2; +267.5) in Group B. For the NAPCOMS, the median (IQR) was lower in Group A than in Group B: [2 (0.0 – 5.0) and 5.0 (2.5 – 6.0) respectively (p=0.185)]. In Group B, 27% of children felt pain (NAPCOMS ≥ 6) compared to 18.2 % in Group A (p=0.47). For children undergoing colonoscopy, 37.5 % felt pain in the placebo arm as compared to 20 % in the Lorazepam arm (absolute difference of 17.5%). No difference was found between groups for adverse events rate. Oral Lorazepam was associated with a decrease of sCortisol and a lower pain score in patients having a colonoscopy. This pilot study had a decent inclusion rate (61% of eligible participants). A large randomized trial assessing the impact of Lorazepam on pain score in children before colonoscopy is therefore feasible. FRQS
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.005 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".