Remimazolam Compared to Propofol During Hysteroscopy: A Safety and Efficacy Analysis

Abstract

Introduction Propofol is the main drug used to induce sedation for endoscopic procedures, and few drugs had shaken its dominant clinical use for a decade until the development of remimazolam. Remimazolam has been demonstrated to perform well in post-marketing studies on sedation for colonoscopy or other procedures requiring short periods of sedation. This study aimed to establish whether remimazolam was effective and safe for inducing sedation for hysteroscopy. Methods One hundred patients who were scheduled to undergo hysteroscopy were randomly assigned to receive induction with remimazolam or propofol. A dose of 0.25 mg/kg remimazolam was administered. Propofol was started at 2–2.5 mg/kg. Before remimazolam or propofol induction, 1 μg/kg fentanyl was infused. Hemodynamic parameters, vital signs, and bispectral index (BIS) values were measured and adverse events recorded to evaluate safety. We comprehensively evaluated the efficacy and safety of the two drugs by the success rate of induction, fluctuation of vital signs, depth of anesthesia, adverse reactions, recovery time, and other indicators. Results Information on 83 patients was successfully recorded and carefully documented. The success rate of sedation in the remimazolam group (group R) was 93%, which was lower than for the propofol group (group P) (100%), but there was no statistically significant difference between the two groups. The incidence of adverse reactions in group R (7.5%) was significantly lower than that in group P (67.4%), and the results were statistically significant ( P < 0.01). The fluctuation of vital signs in group P was more severe after induction, especially in patients with cardiovascular diseases. Conclusions Remimazolam avoids the injection pain produced by propofol sedation, has a better pre-sedation experience, had the advantage of stable hemodynamics after injection compared to propofol, and a lower respiratory depression rate in the study patients.

Efficacy and safety of remimazolam besilate for sedation in outpatients undergoing impacted third molar extraction: a prospective exploratory study

“…Several recent randomized controlled trials have compared remimazolam to propofol in procedural sedation such as gastric endoscopy and hysteroscopy. These studies have consistently demonstrated that the incidence of adverse events was significantly lower in patients administered remimazolam compared to propofol [ 29 – 31 ]. The time to loss of consciousness in the remimazolam group was longer compared to the propofol group [ 29 ].…”

Modified Dixon sequential method to determine the effective dose of alfentanil compounded with propofol for day-case hysteroscopy

“…15 However, it is undeniable that propofol has time- and dose-dependent depressive effects on the cardiovascular and respiratory systems, which limits its use in basic hospitals with a shortage of anesthesiologists and subpar resuscitation facilities. In conjunction with propofol, opioids (such as fentanyl, 16 sufentanil, 5 and remifentanil 3 ) are frequently used for general intravenous anesthetic during day-case surgery for hysteroscopy. Because PK and/or PD interactions may alter medication dose–effect relationships, they are often not explored separately when thinking about therapeutic applications.…”

A self-controlled trial comparing remimazolam to propofol for sedation in cervical cancer patients during interstitial brachytherapy

“…Intravenous injections included sufentanil at 1 ug/kg and granisetron at a 0.3 mg. The sedation regimens were propofol (Yangtze River Pharmaceutical Co., Ltd) at 1.5 mg/kg (P), remimazolam (Yichang Renfu Pharmaceutical Co., Ltd) at 0.3 mg/kg (R1) [6], and remimazolam at 0.2 mg/kg (R2) [7], with regiment allocation randomized using sealed envelopes. The operation began when the Narcotrend index (NI) was ≤ 64 or the Modi ed Observer's Assessment of Alertness/Sedation Scale (MOAA/S) was ≤ 2.…”

“…Propofol is preferred for its rapid onset, quick recovery, and effective sedation, but it may induce respiratory and circulatory inhibition. Alternatively, remimazolam, an ester-based benzodiazepine, offers rapid onset, high clearance [2], minimal effect on hepatic or renal function [3,4], and mild respiratory and circulatory inhibition [5][6][7], It is effective in inducing sedation during bronchoscopy [5,8,9], ERCP [6], and hysteroscopy [7]. This study aimed to evaluate the clinical e cacy and safety of sedation using both propofol and remimazolam in the same patient with cervical cancer undergoing three sessions of interstitial brachytherapy.…”