Efficacy of Pre-Treatment with Remimazolam on Prevention of Propofol-Induced Injection Pain in Patients Undergoing Abortion or Curettage: A Prospective, Double-Blinded, Randomized and Placebo-Controlled Clinical Trial

Effect of Remimazolam Tosilate on Respiratory Depression in Elderly Patients Undergoing Gastroscopy: A Multicentered, Prospective, and Randomized Study

“…The primary outcome was the incidence of respiratory depression, which defined as respiratory rate <8/min and/or oxygen saturation <90% lasted more than 10 seconds from drug administration to fully alert. Secondary outcomes included the following: 1) the sedation success rate, which defined as a) completion of the entire endoscopy procedure; b) no need for rescue sedative medication; and c) up to five additional doses within 15 minutes after the initial dose; 2) time to loss of consciousness (LOC), defined as the time from the initial dose to obtain sufficient sedation [the first MOAA/S score≤3]; 3) time to fully alert, defined as the time from cessation of sedative agent to fully alert [the first of three consecutive MOAA/S score of 5]; 4) time to ready for discharge [modified post-anesthesia discharge scoring system score of ≥9, with 2 points in the vital sign item]; 5) the incidence of hypotension (defined as systolic blood pressure [SBP] decreased by 20% or more than the baseline value or SBP ≤80 mmHg) from drug administration to fully alert; 6) the incidence of treatment-related hypotension (defined as hypotension occurring during sedation and requiring at least one medication); 7) the incidence of adverse events, including but not limited to apnea [absence of breathing lasting 10 seconds or more]; the abnormal SpO 2 during gastroscopy; postoperative nausea and vomiting (PONV); body movement, bradycardia [defined as heart rate less than 50 beat/min], tachycardia [defined as heart rate greater than 120 beat/min], incidence and severity of injection pain, 15 etc; 8) The satisfaction of anesthesiologists, doctors and patients were evaluated using a 10-point scale, which was divided into the following categories: poor, 1-4; Fairness, 5-7; Good, 8-10. 2…”

Remimazolam: An Updated Review of a New Sedative and Anaesthetic

“…15,34,39,40,79 Remimazolam is associated with a low risk of hypotension and respiratory depression and injection site pain in procedural sedation as compared with propofol, 38,80 and pre-treatment with remimazolam is known to reduce the incidence and intensity of propofol-induced injection pain. 81 Furthermore, there were no significant differences in the treatment-related AEs of remimazolam and midazolam. 41,45 The most common treatment-emergent AEs reported in the induction and maintenance of general anaesthesia include hypotension, bradycardia, tachycardia, hypoxia, and vomiting and nausea.…”

Esketamine prevents propofol-induced injection pain: Randomized controlled trial

“…The primary outcomes were incidence of PIP and distribution of pain to different degrees during the induction of anesthesia. An anesthetist performing the anesthesia was blinded to group allocation and was trained to use a four-point pain scale ( Guan et al, 2021 ) in each center to evaluate the severity of PIP continually during induction for all patients. Briefly, grade 0 indicates no pain (negative response to questioning); grade 1, mild pain (pain reported in response to questioning, without behavioral signs); grade 2, moderate pain (pain reported in response to questioning and accompanied by a behavioral sign or pain reported spontaneously); and grade 3, severe pain (strong vocal response or response accompanied by facial grimacing, arm retraction, or tears).…”

“…Many techniques have been developed to reduce the incidence of PIP, including changing the temperature and concentration of propofol ( Jeong and Yoon, 2016 ; Lu et al, 2021 ), controlling the injection speed, selecting large vein vessels ( Canbay et al, 2008 ; Desousa, 2016 ), and transcutaneous electrical acupoint stimulation ( Jin et al, 2022 ). The most common techniques are pre-treatment or mixed use of propofol with drugs such as lidocaine ( Euasobhon et al, 2016 ; Hong et al, 2016 ; Jeong and Yoon, 2016 ; Sun et al, 2016 ; Zirak et al, 2016 ; Xing et al, 2018 ; Tian et al, 2021 ; Wasinwong et al, 2022 ), nonsteroidal anti-inflammatory drugs ( Madan et al, 2016 ; Miniksar, 2022 ), dexmedetomidine ( Yu et al, 2015 ; Lu et al, 2021 ), ketamine ( Cheng et al, 2017 ; Akbari et al, 2018 ), nitrous oxide ( Kaabachi et al, 2007 ), opioids ( Kizilcik et al, 2015 ; Lee et al, 2016 ; Singh et al, 2016 ; Lee et al, 2017 ; Wang et al, 2020 ), benzodiazepines ( Guan et al, 2021 ), and magnesium sulfate ( Sun et al, 2016 ). All of these techniques or drugs attenuated PIP to varying degrees, but their drawbacks, such as laryngospasm ( Batra et al, 2005 ; Kaabachi et al, 2007 ), emergence agitation ( Kaabachi et al, 2007 ), gastrointestinal ulcer ( Madan et al, 2016 ), pulmonary embolism ( Davies et al, 2002 ), lengthy onset ( Wang et al, 2020 ), and tinnitus or dizziness ( Xing et al, 2018 ), limited their clinical use, and PIP could not be completely abolished.…”