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依托咪酯联合丙泊酚与雷米唑仑用于老年患者胃肠道内窥镜镇静的随机前瞻性临床试验
Authors Zhang Q, Zhao R , Wu Y, Zhang L, Feng Y
Received 11 December 2023
Accepted for publication 25 June 2024
Published 2 July 2024 Volume 2024:18 Pages 2681—2692
DOI https://doi.org/10.2147/DDDT.S454314
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Georgios Panos
Qin Zhang,1 Rui Zhao,1 Yaqing Wu,2 Liming Zhang,1 Yi Feng2
1Endoscopy Center, Peking University People’s Hospital, Beijing, People’s Republic of China; 2Department of Anesthesiology, Peking University People’s Hospital, Beijing, People’s Republic of China
Correspondence: Yi Feng, Department of Anesthesiology, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China, Email doctor_yifeng@sina.com
Purpose: Remimazolam is a novel short-acting benzodiazepine used for sedation and general anesthesia. This study aimed to evaluate the efficacy and safety of remimazolam besylate in elderly patients who underwent diagnostic gastrointestinal endoscopy.
Patients and Methods: A total of 120 patients aged 60– 75 years were randomly allocated to one of two groups. Remifentanil 0.3μg/kg was used for analgesia. Patients were administered remimazolam besylate 7 mg (R group) or etomidate 0.1 mg/kg combined with 1% propofol 0.5 mg/kg (EP group) for induction, supplemental repeated doses were given as needed. Some time metrics, vital signs, adverse events were evaluated. Patients’ Mini-cog score and recovery questionnaires were compared.
Results: Compared to the EP group, the induction time was slightly longer in the R group (1.50 VS 1.15 minutes) (P< 0.05), the time spent in the post-anesthesia care unit (PACU) was shorter (15.17 VS 17.40 minutes) (P< 0.05). Compare with EP group, SBP was lower in R group at T15 and T25 time point, but heart rate was higher in T2, T3, T5 (P< 0.05). The Mini-Cog score was higher after the procedure (2.83 VS 2.58) (P< 0.05). The incidence of respiratory adverse events was higher in the EP group than R group (18.3% VS 5.0%, P < 0.05). The most common adverse event in R group was hiccups. The sedation satisfaction rate and degree of amnesia were higher in the R group (66.7% VS 11.7%) (P < 0.05), and the effect on patient’s life within 24 hours was lower (12.0% VS 30.5%) (P < 0.05).
Conclusion: The safety and efficacy of remimazolam besylate are not inferior to those of etomidate combined with propofol, rendering it a safe option for sedation during gastrointestinal endoscopy in ASA I-II elderly patients, but care should be taken to monitor the occurrence of hiccups.
Keywords: gastrointestinal endoscopy, anesthesia, remimazolam besylate, etomidate, propofol