The Clinical Application of Remimazolam Benzenesulfonate Combined with Esketamine Intravenous Anesthesia in Endoscopic Retrograde Cholangiopancreatography

Yi, Xiuna; Xu, Weiwei; Li, Aizhi

doi:10.1155/2022/5628687

Cited by 9 publications

(12 citation statements)

References 31 publications

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“…Studies have shown that esketamine combined with propofol or remimazolam for procedural sedation can maintain stable hemodynamics and reduce the incidence of adverse events ( Chen et al, 2022 ; Xu et al, 2022 ; Yi et al, 2022 ; Zhan et al, 2022 ; Zheng et al, 2022 ). Zhao et al reported that 84.8% of injection pain occurred in pediatric patients with propofol, which could be reduced by ketamine pretreatment ( Zhao et al, 2012 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of remimazolam and propofol combined with low dose esketamine for pediatric same-day painless bidirectional endoscopy: a randomized, controlled clinical trial

Chu,

Zhou,

Wan

et al. 2024

Front. Pharmacol.

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Background: Remimazolam has shown similar or even superior properties to propofol in procedural sedation in adults, but few studies have been conducted in pediatric populations. Thus, we aimed to compare the effect and safety of remimazolam and propofol combined with low dose esketamine for pediatric same-day bidirectional endoscopy (BDE).Methods: Pediatrics <18 years scheduled for elective BDE under sedation were included and randomly assigned to remimazolam group (R group) or propofol group (P group). The primary outcome was the success rate of sedation. Secondary outcomes include sedation-related information and adverse events. Mean arterial pressure (MAP), heart rate (HR), and perfusion index (PI) were recorded during sedation.Results: A total of 106 patients were enrolled and analyzed. The success rate of sedation was 100% in both groups. Compared with the P group, the induction time of the R group was significantly prolonged (p < 0.001), and the incidence of injection pain, intraoperative respiratory depression, hypotension and bradycardia was significantly lower (p < 0.001). The changes in MAP, HR and PI were relatively stable in the R group compared with the P group. Additionally, awake time significantly decreased with age by approximately 1.12 index points for each increase in age in the P group (p = 0.002) but not in the R group (p > 0.05). Furthermore, the decline in PI and PI ratio during BDE was related to body movement in the P group.Conclusion: Remimazolam combined with low dose esketamine has a non-inferior sedative effect than propofol for pediatric BDE, with no injection pain, less respiratory depression, more stable hemodynamics. Moreover, early detection of the decline in PI may avoid harmful stimulation under light anesthesia.Clinical trial registration:https://www.clinicaltrials.gov/study/NCT05686863?id=NCT05686863&rank=1, NCT05686863

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Section: Discussionmentioning

confidence: 99%

Comparison of remimazolam and propofol combined with low dose esketamine for pediatric same-day painless bidirectional endoscopy: a randomized, controlled clinical trial

Chu,

Zhou,

Wan

et al. 2024

Front. Pharmacol.

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“…It is consistent with a study on S‐ketamine in treating vascular response to depression. Intravenous injection of S‐ketamine (0.5 mg/kg) reduced HR and blood pressure fluctuations, thus stabilizing hemodynamics 31 . This is because hemodynamic disorders in clinical anesthesia often manifest as negative changes caused by inhibition of the sympathetic system, but the sympathomimetic effect of S‐ketamine counteracts this unfavorable fluctuation.…”

Section: Discussionmentioning

confidence: 99%

Thrifty effect of subanesthetic‐dose S‐ketamine on postoperative opioids and its safety and analgesic effectiveness: A prospective, triple‐blind, randomized controlled, polycentric clinical trial

Ding,

Yu,

Luo

et al. 2023

Ibrain

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Aim: To investigate the thrifty effects of subanesthetic-dose S-ketamine on postoperative opioids and its safety and analgesic efficacy. Methods: Four-hundred and twenty patients were divided into the control group (CON group), the S-ketamine 0.2 mg/kg group (ES0.2 group), and the S-ketamine 0.3 mg/kg group (ES0.3 group) randomly. Major indicators include the Visual Analogue Scale (VAS), the times of compression with analgesic pumps after surgery, and analgesic drug consumption from anesthesia induction to 48 h after surgery. Minor records include vital signs, the use of vasoactive drugs, the Ramsay scores, the occurrence of adverse events including nervous system reaction, and the patient's satisfaction with anesthesia.Results: Compared with the CON group, VAS scores decreased in the ES0.2 and ES0.3 groups (p < 0.05). At 10 min after extubation, the VAS scores of the ES0.3 group were lower than that of the ES0.2 group (p < 0.05). The total number of compression with analgesic pumps of the ES0.3 group was lower than that of the CON group (p < 0.05). The opioid consumption after surgery of the ES0.3 group was lower than those of the CON group and the ES0.2 group (p < 0.05). The ES0.3 group's heart rate (HR) was faster but the use of vasoactive, drug consumption was less than the other two groups (p < 0.05).There were no significant differences in the incidence of postoperative adverse events and anesthetic satisfaction among the three groups.Conclusion: Subanesthetic-dose S-ketamine at 0.2-0.3 mg/kg especially the 0.3 mg/kg in general anesthesia induction can safely and effectively reduce postoperative pain and save postoperative opioid consumption.

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“…Previous trials have consistently demonstrated that remimazolam has a better safety profile than propofol, including less bradycardia treatment requirement, a lower incidence of hypotension, and less injection pain 18,19,34,35,39,40,43,44,46 . However, propofol was less likely to develop postoperative nausea and vomiting (PONV) 19,46 .…”

Section: Discussionmentioning

confidence: 99%

“…28,33 Due to its analgesic properties, esketamine can potentially alleviate pain experienced by patients during surgical abortion, minimizing pain-induced body movements, and fluctuations in hemodynamics during the procedure. Remimazolam coadministrated with esketamine (R + E) could provide both effective sedation and analgesia for routine outpatient procedures, which could be an alternative to the increasingly used P + E. The combination use of R + E has been shown to have better profiles over propofol co-administered with sufentanil 34 and fentanyl 35 for procedures like gastroscopy co-administrated with other analgesics. Esketamine is increasingly used in combination with propofol (P + E), to reduce propofol consumption and propofolinduced injection pain.…”

Section: Introductionmentioning

confidence: 99%

Remimazolam versus propofol in combination with esketamine for surgical abortion: A double‐blind randomized controlled trial

Yue¹,

Ma²,

Li³

et al. 2023

Clinical Translational Sci

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Remimazolam is a new benzodiazepine with a short half‐life, good efficacy, and safety profiles in general anesthesia. Combining esketamine with propofol (P + E) could reduce propofol consumption and injection pain. It is, however, unclear if a low dose of remimazolam co‐administrated with esketamine (R + E) is comparable to the increasingly used P + E for surgical abortion with general anesthetic. We conducted a double‐blind randomized controlled trial to compare the efficacy and safety of R + E and P + E. Two hundred patients scheduled for a surgical abortion were randomized to receive remimazolam 0.3 mg/kg plus esketamine 0.3 mg/kg (R + E), and propofol 2 mg/kg plus esketamine 0.3 mg/kg (P + E). Sedative effectiveness was evaluated by measuring the time to lose consciousness (LOC), recovery time, and successful sedation rate. Safety was assessed by hemodynamics and adverse events during and postoperation. The time to LOC and recovery time in R + E was 5 s shorter and 1 min longer than that in P + E, respectively (both p < 0.001). Success sedation rate did not differ between groups (p = 0.73). Bradycardia incidence and injection site pain were less frequent in the R + E group than that in the P + E group. More rash was observed in the R + E group compared with the P + E group (32% vs. 5%, p < 0.001), but all were mild (only chest rash) and resolved subsequently. Low dose of remimazolam when combined with esketamine has favorable profiles with rapid onset and recovery, but mild hemodynamic side effects and adverse events. It can be used as an alternative for surgical abortion with general anesthetic.

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The Clinical Application of Remimazolam Benzenesulfonate Combined with Esketamine Intravenous Anesthesia in Endoscopic Retrograde Cholangiopancreatography

Cited by 9 publications

References 31 publications

Comparison of remimazolam and propofol combined with low dose esketamine for pediatric same-day painless bidirectional endoscopy: a randomized, controlled clinical trial

Comparison of remimazolam and propofol combined with low dose esketamine for pediatric same-day painless bidirectional endoscopy: a randomized, controlled clinical trial

Thrifty effect of subanesthetic‐dose S‐ketamine on postoperative opioids and its safety and analgesic effectiveness: A prospective, triple‐blind, randomized controlled, polycentric clinical trial

Remimazolam versus propofol in combination with esketamine for surgical abortion: A double‐blind randomized controlled trial

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