Sedative effect of remimazolam combined with alfentanil in colonoscopic polypectomy: a prospective, randomized, controlled clinical trial

Xin, Yueyang; Chu, Tiantian; Wang, Jinxu; Xu, Anjian

doi:10.1186/s12871-022-01805-3

Cited by 18 publications

(15 citation statements)

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“…Previous studies confirmed that RT could be safely and effectively used for sedation in outpatient surgeries, such as gastrointestinal endoscopy (Rex et al, 2018;Lu et al, 2022;Xin et al, 2022), bronchoscopy (Pastis et al, 2019), tooth extraction (Zhao et al, 2022), hysteroscopy (Zhang et al, 2021), or induction and maintenance of general anesthesia (Zhou et al, 2020;Mao et al, 2022). RT could also provide enough sedative effect and safety for special patients, such as elderly patients (Liu et al, 2022;Tan et al, 2022) and patients with liver cirrhosis (Cao et al, 2022).…”

Section: Discussionmentioning

confidence: 93%

Safety and effectiveness of the combination of remimazolam tosilate and propofol in gastroscopy: a multicenter, randomized controlled, single-blind clinical trial

et al. 2023

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Remimazolam tosilate (RT) is a new short-acting γ-aminobutyric acid A (GABAA) receptors agonist. However, its optimal use mode and dosage still remain unclear. This study aimed to examine the safety and effectiveness of the combination of RT and propofol in gastroscopy. This was a prospective, single-blind, randomized, multicenter, parallel-group study. All eligible 256 patients were randomized into the following 3 groups. Patients were anesthetized with propofol (Group P), RT (Group R) or the combination of RT and propofol (Group RP). The primary efficacy endpoints were: body movement score; satisfaction of gastroscopy doctors; success rate of sedation and effects on sleep status. Sedation induction time, time to be fully alert and adverse events were also recorded. The probability of complete immobility was lower in group R (33.73%) than in group P (86.67%) and RP (83.13%). The rate of doctors’ satisfaction was much lower in group R (28.92%) than in group P (77.78%) and RP (72.29%). The success rate of sedation and sleep outcome score has no difference in the three groups. The time to adequate sedation was longer in group RP (77.27 ± 18.63 s) than in group P (64.47 ± 24.36 s), but much shorter than that in group R (102.84 ± 46.43s). The time to be fully alert was shorter in group R (6.30 ± 1.52 min) and RP (6.54 ± 1.13 min) than in group P (7.87 ± 1.08 min). The proportion of sedative hypotension was significantly higher in group P (41.11%) than in group R (1.20%) and group RP (3.61%) (p < 0.001). The incidence of respiratory depression was much higher in group P (17.78%) than in group R (no patient) and group RP (1.2%). The incidence of adverse events was lower in groups R (4.82%) and RP (9.64%) than in group P (31.11%). The combination of RT and propofol takes effect quickly, makes patients alert quickly, provides a sufficient depth of sedation, reduces body movement, does not inhibit circulation and respiratory function, does not affect sleep, and is the preferred mode for gastroscopy doctors and anesthesiologists.

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Section: Discussionmentioning

confidence: 93%

Safety and effectiveness of the combination of remimazolam tosilate and propofol in gastroscopy: a multicenter, randomized controlled, single-blind clinical trial

et al. 2023

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“…Alfentanil is widely used in intravenous general anesthesia. The combination of alfentanil and dexmedetomidine, ketamine or propofol has been well used in various short and minor operations [1,[20][21][22] .Previous studies on alfentanil mainly focused on the use of single bolus injection or on-demand administration of alfentanil [23] .In this study, continuous infusion can improve the quality of sedation and analgesia, rapidly adjust the depth of anesthesia, and signi cantly reduce the occurrence of hemodynamic uctuations and respiratory depression. We found that the incidence of respiratory depression in the high dose group of alfentanil increased signi cantly, indicating that when the dosage of alfentanil reached 0.35µg/kg/min, the safety of respiration decreased signi cantly.…”

Section: Discussionmentioning

confidence: 99%

Comparison of anesthetic effects of different doses of alfentanil combined with ciprofol in elderly patients undergoing ERCP :a randomized controlled trial

Zhu

et al. 2023

Preprint

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Background and Objects: Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) are often old and poor in physical fitness. The purpose of this study was to investigate the anesthetic effect of different doses of alfentanil combined with ciprofol in elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Methods: In this clinical trial, 137 patients, who were candidates for ERCP were randomly divided into three groups. Group A were given 0.15 µg/kg/min of alfentanil in maintenance stage, Group B were given 0.25 µg/kg/min and Group C were given 0.35 µg/kg/min. Mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO2) of the patients at each time point including the entry into the operation room (T0), at the beginning of surgery(T1), 10 minutes after surgery(T2), 20 minutes after surgery(T3), 30 minutes after surgery(T4),endoscopy withdrawal (T5) were recorded. Adverse events(including respiratory depression, body movement and hypoxemia),the dosage of ciprofen, the time of operation time and awakening were recorded. Results: Compared with Group A, MAP and HR in Group B and Group C was decreased during T1-T5 (P < 0.05). Compared with group B, MAP and HR in group C was decreased during T1-T5 (P < 0.05). Compared with Group A and Group C ,the number of adverse reactions of Group B was decreased(P < 0.05). There was no statistical difference in surgical time among the three groups(P>0.05) ,but t a statistically significant difference in recovery time (P < 0.05). Conclusion: The adverse events of alfentanil 0.25µg/kg/min combined with ciprofol were low, and the anesthetic effect was the best.

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“…The current study also showed that TLOC and ADS 50 were higher in the group receiving remimazolam than those in the group receiving propofol during remifentanilbased TIVA; this result is consistent with the results of previous studies. BIS and the Modified Observer Assessment of Alertness and Sedation (MOAA/S) scores have been used in previous comparative studies on the effects of remimazolam and propofol on the depth of anesthesia (17)(18)(19)(20). However, BIS was originally developed for monitoring the depth of propofol-based anesthesia, and there is a weak correlation between benzodiazepine-induced anesthetic depth and BIS (4).…”

Section: Tloc and Anesthetic Depthmentioning

confidence: 99%

Safety and efficacy of remimazolam for general anesthesia in elderly patients undergoing laparoscopic cholecystectomy: a randomized controlled trial

So,

Park,

Kim

2023

Front. Med.

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IntroductionThere is insufficient evidence regarding the efficacy and safety of remimazolam in elderly patients. Therefore, this study evaluated the differences in the anesthesia characteristics and perioperative hemodynamic profiles of elderly patients receiving total intravenous anesthesia with remimazolam or propofol.MethodsEighty-four patients aged >65 years with an American Society of Anesthesiologists physical status of I–III were randomly assigned to Group R (receiving remimazolam, n = 42) or Group P (receiving propofol, n = 42). In Group R, remimazolam was initiated at a rate of 6 mg/kg/h until loss of consciousness (LOC) was achieved and maintained at 1 mg/kg/h subsequently. In Group P, 1.0–1.5 mg/kg of propofol was injected for 1 min and maintained at 100 μg/kg/min subsequently. The maintenance infusion rate was adjusted to maintain an appropriate depth of anesthesia until the end of the surgery. The primary outcome was the time to LOC. The depth of anesthesia scores and hemodynamic profiles were recorded perioperatively.ResultsThe time to LOC was significantly longer in Group R (120 s) than in Group P (60 s) (p < 0.001). The time to eye-opening (Group R, 10 min; Group P, 10 min; p = 0.056), the incidence of maintenance of hemodynamic changes within 20% of the peri-anesthetic values, and treatments for hemodynamic instability did not differ significantly between the groups. The depth of anesthesia scores did not differ significantly between the groups; however, the scores were higher in Group R than those in Group P before endotracheal intubation. The hemodynamic parameters did not differ significantly at any time point. The time to extubation was longer in Group R (12 min) than that in Group P (10 min) (p = 0.007). Similarly, the time to discharge from the operating room was significantly longer in Group R (15 min) compared to Group P (12 min) (p = 0.018).ConclusionRemimazolam does not exhibit a comparable effect to propofol in terms of anesthesia induction and recovery. However, it demonstrates a similar effect to propofol regarding intraoperative anesthesia depth and hemodynamic profile in elderly patients undergoing remifentanil-based total intravenous anesthesia.

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Sedative effect of remimazolam combined with alfentanil in colonoscopic polypectomy: a prospective, randomized, controlled clinical trial

Cited by 18 publications

References 50 publications

Safety and effectiveness of the combination of remimazolam tosilate and propofol in gastroscopy: a multicenter, randomized controlled, single-blind clinical trial

Safety and effectiveness of the combination of remimazolam tosilate and propofol in gastroscopy: a multicenter, randomized controlled, single-blind clinical trial

Comparison of anesthetic effects of different doses of alfentanil combined with ciprofol in elderly patients undergoing ERCP :a randomized controlled trial

Safety and efficacy of remimazolam for general anesthesia in elderly patients undergoing laparoscopic cholecystectomy: a randomized controlled trial

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