Surgical Anesthesia Center, Zigong Hospital of TCM, Zigong, 643000, People's Republic of China.
Department of Anesthesia, Da'an District Maternal and Child Health Hospital, Zigong, 643000, People's Republic of China.
Drug Des Devel Ther. 2024 Nov 19;18:5269-5280. doi: 10.2147/DDDT.S490179. eCollection 2024.
The debate continues over the differential impact of remimazolam vs propofol on hemodynamic stability. This study aims to elucidate the effects of a combination of remimazolam and esketamine vs propofol and esketamine on hemodynamic parameters in elderly patients undergoing painless colonoscopies.
We conducted a randomized controlled trial involving 754 patients, divided equally between two treatment groups. The remimazolam-esketamine group (RE group) received 0.15 mg/kg of remimazolam and 0.3 mg/kg of esketamine. Conversely, the propofol-esketamine group (PE group) was administered 1.5 mg/kg of propofol with 0.3 mg/kg of esketamine. Primary outcomes focused on the incidence of hypotension. Secondary outcomes assessed were other hemodynamic adverse events, intraoperative blood pressure and heart rate fluctuations, usage of vasoactive agents, sedation efficacy, and additional adverse reactions.
Hypotension occurred significantly less frequently in the RE group (9.78%, 95% confidence interval[CI]: 6.67-12.87%) compared to the PE group (23.57%, 95% CI: 21.22-30.52%), <0.001. The RE group also showed lower incidences of sinus tachycardia, sinus bradycardia, and required less support from vasoactive agents (<0.001). Additionally, the RE group experienced smaller fluctuations in blood pressure and heart rate (<0.05). Both groups achieved a 100% sedation success rate. Notably, the RE group had a longer induction period but a quicker recovery time (<0.001), and lower rates of respiratory depression (=0.006) and injection pain (<0.001).
Remimazolam combined with esketamine offers superior hemodynamic stability and significantly reduces adverse event rates compared to propofol plus esketamine in elderly patients undergoing painless colonoscopies, while maintaining effective sedation.
关于雷米昔泮与丙泊酚对血流动力学稳定性的影响差异，争议仍在继续。本研究旨在阐明雷米昔泮联合依托咪酯与丙泊酚联合依托咪酯对行无痛结肠镜检查的老年患者血流动力学参数的影响。
我们开展了一项随机对照试验，共纳入 754 例患者，平均分为两组。雷米昔泮-依托咪酯组（RE 组）给予 0.15mg/kg 雷米昔泮和 0.3mg/kg 依托咪酯。相反，丙泊酚-依托咪酯组（PE 组）给予 1.5mg/kg 丙泊酚和 0.3mg/kg 依托咪酯。主要结局为低血压的发生率。次要结局为其他血流动力学不良事件、术中血压和心率波动、血管活性药物的使用、镇静效果以及其他不良反应。
RE 组（9.78%，95%置信区间[CI]：6.67%-12.87%）发生低血压的频率显著低于 PE 组（23.57%，95%CI：21.22%-30.52%），<0.001。RE 组还显示窦性心动过速、窦性心动过缓的发生率更低，且需要的血管活性药物支持更少（<0.001）。此外，RE 组的血压和心率波动较小（<0.05）。两组的镇静成功率均为 100%。值得注意的是，RE 组的诱导时间较长，但恢复时间更快（<0.001），呼吸抑制发生率较低（=0.006），注射疼痛发生率较低（<0.001）。
与丙泊酚联合依托咪酯相比，雷米昔泮联合依托咪酯在接受无痛结肠镜检查的老年患者中提供了更好的血流动力学稳定性，并显著降低了不良事件的发生率，同时保持了有效的镇静。
