An observational association can reflect why sedation was selected as well as what it did.
A single endoscopist’s records covered 4,422 screening examinations. Poor cooperation was recorded in 8.1%, and some of those examinations were incomplete. Midazolam procedural sedation, younger age, body mass index and several patient characteristics were associated with poor cooperation in the multivariable analysis.
Cooperation was judged subjectively, and sedation was not randomly assigned. Patients expected to have difficulty may have been more likely to receive medication. A single-operator design reduces between-operator variation but limits broader representation and does not remove treatment-selection bias.
For testimony, distinguish association from proof of a paradoxical benzodiazepine reaction. The behavioral sequence before and after administration, dose and operator observations matter. The study does not justify assuming that avoiding midazolam would have made the same patients cooperate better.
Source: Publication PMC5583449, read from the supplied PDF. Applications to expert analysis are interpretation.
Related reading: Palliative Bladder-Care Cohort Associated Benzodiazepines With Catheter Use.