Fan Shunyi, Zhu Yun, Sui Changzhong, Li Qian, Jiang Wenxin, Zhang Li
Service of Department of Anaesthesiology, The Ninth People's Hospital of Chongqing, Chongqing, 400700, China.
The Ninth People's Hospital of Chongqing, Chongqing, China.
Pain Ther. 2023 Jun;12(3):695-706. doi: 10.1007/s40122-023-00483-4. Epub 2023 Mar 11.
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.
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.
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.
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.
丙泊酚是用于内镜手术诱导镇静的主要药物，在瑞马唑仑出现之前，十年来很少有药物能撼动其在临床中的主导地位。瑞马唑仑已在结肠镜检查或其他需要短期镇静的手术后研究中表现良好。本研究旨在确定瑞马唑仑用于宫腔镜检查诱导镇静是否有效和安全。
将100例计划进行宫腔镜检查的患者随机分为接受瑞马唑仑或丙泊酚诱导组。给予0.25mg/kg瑞马唑仑。丙泊酚起始剂量为2-2.5mg/kg。在瑞马唑仑或丙泊酚诱导前，输注1μg/kg芬太尼。测量血流动力学参数、生命体征和脑电双频指数（BIS）值，并记录不良事件以评估安全性。我们通过诱导成功率、生命体征波动、麻醉深度、不良反应、恢复时间等指标综合评估两种药物的有效性和安全性。
成功记录并仔细记录了83例患者的信息。瑞马唑仑组（R组）的镇静成功率为93%，低于丙泊酚组（P组）（100%），但两组之间无统计学显著差异。R组的不良反应发生率（7.5%）明显低于P组（67.4%），结果具有统计学意义（P<0.01）。诱导后P组生命体征波动更严重，尤其是患有心血管疾病的患者。
瑞马唑仑避免了丙泊酚镇静引起的注射疼痛，具有更好的镇静前体验，与丙泊酚相比，注射后血流动力学稳定，且本研究患者的呼吸抑制率较低。
