Remimazolam tosilate infusion has a lower incidence of hypotension than propofol infusion during painless colonoscopy

Abstract

Background: Remimazolam tosilate is an ultra-short-acting sedative drug with the advantages of rapid onset and recovery, mild respiratory, and circulatory inhibition. This study primarily investigated the effect of remimazolam on incidence of intraoperative hypotension compared to the widely used propofol in patients undergoing outpatient painless colonoscopy.
 Methodology: This was a double-blinded, randomized, controlled trial. We randomly divided the eligible patients with outpatient appointment for painless colonoscopy in our hospital into the remimazolam group and the propofol group. The modified observer’s assessment of alert/sedative was used to evaluate the depth of the patient's sedation. The Narcotrend score was monitored throughout the whole process. In the propofol group, propofol 0.5-1.5 mg/kg was infused intravenously as a loading dose, followed by 3-5 mg/kg/h to maintain a satisfied sedation depth during operation. While, with regarding to the patients in remimazolam group, remimazolam 0.05-0.15 mg/kg was induced intravenously as a loading dose, and continuously pumped at a rate of 0.3-0.5 mg/kg/h. SPSS 23.0 software was used to analyze the data.
 Results: From December 2020 to March 2021, we enrolled 116 eligible patients. The incidence of hypotension during sedation (13.8%) in the remimazolam group was significantly lower than that in propofol (37.9%), and the success rate of remimazolam (98.3%) was slightly lower than propofol (100.0%), but the awakening time was significantly shorter (P < 0.001); The incidence of respiratory inhibition, nausea, vomiting and other adverse events during colonoscopy, remimazolam was significantly lower than that of propofol (P < 0.05).
 Conclusion: Remimazolam tosilate still has higher circulatory stability than propofol in painless colonoscopy under continuous administration with a loading dose.
 Trial registration: The trial was registered at the Chinese Clinical Trial Registry (ChiCTR2000040557), data of registration: December 2020.
 Abbreviations: BMI- Body Mass Index; MOAA/S- Modified Observer’s Assessment of Alert Scale; MAP- Mean Arterial Pressure; Rem- Remimazolam; Pro- Propofol
 
 Key words: Remimazolam tosilate; Propofol; Painless Colonoscopy; Hypotension
 Citation: Li S, Zhang Y, Wang H, Ye G, Yao N, Zhu X. Continuous remimazolam tosilate infusion has a lower incidence of hypotension than propofol infusion for sedation in painless colonoscopy. Anaesth. pain intensive care 2022;27(6):697−705; DOI: 10.35975/apic.v27i6.2341
 Received: Aug 27, 2023; Revised: October 16, 2023; Accepted: October 16, 2023