Etomidate Combined with Propofol versus Remimazolam for Sedation in Elderly Patients During Gastrointestinal Endoscopy: A Randomized Prospective Clinical Trial

IF 4.7 2区医学 Q1 CHEMISTRY, MEDICINAL Drug Design, Development and Therapy Pub Date : 2024-07-02 DOI:10.2147/dddt.s454314

Qin Zhang, Rui Zhao, Yaqing Wu, Liming Zhang, Yi Feng

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Abstract

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

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依托咪酯联合丙泊酚与雷马唑仑在消化道内窥镜检查中对老年患者的镇静作用对比：随机前瞻性临床试验

目的：雷米唑仑是一种新型短效苯并二氮杂卓，用于镇静和全身麻醉：雷马唑仑是一种新型短效苯二氮卓类药物，用于镇静和全身麻醉。本研究旨在评估苯磺酸雷马唑仑对接受消化道内窥镜检查的老年患者的疗效和安全性：共有 120 名 60-75 岁的患者被随机分配到两组中的一组。使用瑞芬太尼 0.3μg/kg 进行镇痛。患者在诱导时使用苯磺酸瑞马唑仑 7 毫克（R 组）或依托咪酯 0.1 毫克/千克联合 1%丙泊酚 0.5 毫克/千克（EP 组），并根据需要补充重复剂量。对一些时间指标、生命体征和不良事件进行了评估。比较了患者的Mini-cog评分和恢复情况问卷：与 EP 组相比，R 组的诱导时间稍长（1.50 VS 1.15 分钟）（P< 0.05），在麻醉后护理病房（PACU）的时间较短（15.17 VS 17.40 分钟）（P< 0.05）。与 EP 组相比，R 组在 T15 和 T25 时间点的 SBP 更低，但在 T2、T3 和 T5 心率更高（P< 0.05）。术后 Mini-Cog 评分更高（2.83 VS 2.58）（P< 0.05）。EP 组呼吸系统不良事件的发生率高于 R 组（18.3% VS 5.0%，P< 0.05）。R 组最常见的不良反应是打嗝。R组的镇静满意率和失忆程度较高（66.7% VS 11.7%）（P <0.05），24小时内对患者生活的影响较低（12.0% VS 30.5%）（P <0.05）：结论：苯乙酸瑞马唑仑的安全性和有效性并不亚于依托咪酯联合异丙酚，是ASA I-II老年患者胃肠道内窥镜检查期间镇静的安全选择，但应注意监测打嗝的发生。

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来源期刊

Drug Design, Development and Therapy CHEMISTRY, MEDICINAL-PHARMACOLOGY & PHARMACY

CiteScore

9.00

自引率

0.00%

发文量

382

审稿时长

>12 weeks

期刊介绍： Drug Design, Development and Therapy is an international, peer-reviewed, open access journal that spans the spectrum of drug design, discovery and development through to clinical applications. The journal is characterized by the rapid reporting of high-quality original research, reviews, expert opinions, commentary and clinical studies in all therapeutic areas. Specific topics covered by the journal include: Drug target identification and validation Phenotypic screening and target deconvolution Biochemical analyses of drug targets and their pathways New methods or relevant applications in molecular/drug design and computer-aided drug discovery* Design, synthesis, and biological evaluation of novel biologically active compounds (including diagnostics or chemical probes) Structural or molecular biological studies elucidating molecular recognition processes Fragment-based drug discovery Pharmaceutical/red biotechnology Isolation, structural characterization, (bio)synthesis, bioengineering and pharmacological evaluation of natural products** Distribution, pharmacokinetics and metabolic transformations of drugs or biologically active compounds in drug development Drug delivery and formulation (design and characterization of dosage forms, release mechanisms and in vivo testing) Preclinical development studies Translational animal models Mechanisms of action and signalling pathways Toxicology Gene therapy, cell therapy and immunotherapy Personalized medicine and pharmacogenomics Clinical drug evaluation Patient safety and sustained use of medicines.