Dahiya Dushyant Singh, Kumar Ganesh, Parsa Syeda, Gangwani Manesh Kumar, Ali Hassam, Sohail Amir Humza, Alsakarneh Saqr, Hayat Umar, Malik Sheza, Shah Yash R, Pinnam Bhanu Siva Mohan, Singh Sahib, Mohamed Islam, Rao Adishwar, Chandan Saurabh, Al-Haddad Mohammad
Division of Gastroenterology, Hepatology & Motility, The University of Kansas School of Medicine, Kansas City, MO 66160, United States.
Department of Internal Medicine, Chandka Medical College, Sindh 77280, Pakistan.
World J Gastrointest Endosc. 2024 Jul 16;16(7):385-395. doi: 10.4253/wjge.v16.i7.385.
Worldwide, a majority of routine endoscopic procedures are performed under some form of sedation to maximize patient comfort. Propofol, benzodiazepines and opioids continue to be widely used. However, in recent years, Remimazolam is gaining immense popularity for procedural sedation in gastrointestinal (GI) endoscopy. It is an ultra-short-acting benzodiazepine sedative which was approved by the Food and Drug Administration in July 2020 for use in procedural sedation. Remimazolam has shown a favorable pharmacokinetic and pharmacodynamic profile in terms of its non-specific metabolism by tissue esterase, volume of distribution, total body clearance, and negligible drug-drug interactions. It also has satisfactory efficacy and has achieved high rates of successful sedation in GI endoscopy. Furthermore, studies have demonstrated that the efficacy of Remimazolam is non-inferior to Propofol, which is currently a gold standard for procedural sedation in most parts of the world. However, the use of Propofol is associated with hemodynamic instability and respiratory depression. In contrast, Remimazolam has lower incidence of these adverse effects intra-procedurally and hence, may provide a safer alternative to Propofol in procedural sedation. In this comprehensive narrative review, highlight the pharmacologic characteristics, efficacy, and safety of Remimazolam for procedural sedation. We also discuss the potential of Remimazolam as a suitable alternative and how it can shape the future of procedural sedation in gastroenterology.
在全球范围内，大多数常规内镜检查程序都是在某种形式的镇静下进行的，以最大程度地提高患者的舒适度。丙泊酚、苯二氮䓬类药物和阿片类药物仍被广泛使用。然而，近年来，瑞马唑仑在胃肠（GI）内镜检查的程序镇静中越来越受欢迎。它是一种超短效苯二氮䓬类镇静剂，于2020年7月获得美国食品药品监督管理局批准用于程序镇静。瑞马唑仑在通过组织酯酶的非特异性代谢、分布容积、全身清除率以及可忽略不计的药物相互作用方面显示出良好的药代动力学和药效学特征。它还具有令人满意的疗效，并且在胃肠内镜检查中成功镇静率很高。此外，研究表明瑞马唑仑的疗效不劣于丙泊酚，而丙泊酚目前是世界上大多数地区程序镇静的金标准。然而，丙泊酚的使用与血流动力学不稳定和呼吸抑制有关。相比之下，瑞马唑仑在术中这些不良反应的发生率较低，因此，在程序镇静中可能为丙泊酚提供更安全的替代方案。在这篇全面的叙述性综述中，重点介绍瑞马唑仑用于程序镇静的药理学特征、疗效和安全性。我们还讨论了瑞马唑仑作为合适替代方案的潜力以及它如何塑造胃肠病学中程序镇静的未来。
