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Int J Med Sci 2024; 21(7):1250-1256. doi:10.7150/ijms.93045 This issue Cite

Research Paper

Comparison of the recovery time of remimazolam besylate and propofol for gastrointestinal endoscopy sedation in elderly patients

Hai-yan Chen, MD^1,2*, Xiao-xi Wang, MD^3*, Yu-gang Lu, MD^4*, Shu-heng Tang, MD², Tong Ding, MD², Jin-Chao Song, MD^2✉, Gang Chen, MD^1✉

1. Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
2. Department of Anesthesiology, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China.
3. Department of Anesthesiology, Eastern Hepatobillary Surgical Hospital, Naval Medical University, Shanghai, China.
4. Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
* Hai-yan Chen, Xiao-xi Wang and Yu-gang Lu, contributed equally to this work.

✉ Corresponding authors: Jin-chao Song, Department of Anesthesiology, Shidong Hospital of Shanghai, University of Shanghai for Science and Technology, Shiguang Rd., No. 999, Shanghai, China. E-mail: sjch2013com; Gang Chen, Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Qingchun East Road No. 3, Hangzhou, China. E-mail: chengang120edu.cn. More

Abstract

Background: Recovery time is a crucial factor in ensuring the safety and effectiveness of both patients and endoscopy centers. Propofol is often preferred due to its fast onset and minimal side effects. Remimazolam is a new intravenous sedative agent, characterized by its rapid onset of action, quick recovery and organ-independent metabolism. Importantly, its effect can be specifically antagonized by flumazenil. The primary goal of this study is to compare the recovery time of remimazolam besylate and propofol anesthesia during endoscopic procedures in elderly patients.

Methods: 60 patients aged 65-95 years who underwent gastrointestinal endoscopy were randomly and equally assigned to two groups: the remimazolam group (Group R) and the propofol group (Group P). The primary measure was the recovery time, defined as the time from discontinuing remimazolam or propofol until reaching an Observer's Assessment of Alertness and Sedation scale (OAA/S) score of 5 (responds readily to name spoken in normal tone). The time required to achieve an OAA/S score of 3 (responds after name spoken loudly or repeatedly along with glazed marked ptosis) was also recorded and compared.

Results: The recovery time for Group R (2.6 ± 1.6 min) was significantly shorter than that for Group P (10.8 ± 3.0 min), with a 95% confidence interval (CI): 6.949-9.431 min, p <0.001. Similarly, the time to attain an OAA/S score of 3 was significantly less in Group R (1.6 ± 0.9 min) compared to Group P (9.6 ± 2.6 min), with a 95% CI: 6.930-8.957 min, p <0.001.

Conclusion: Our study demonstrated that remimazolam anesthesia combined with flumazenil antagonism causes a shorter recovery time for elderly patients undergoing gastrointestinal endoscopy compared to propofol. Remimazolam followed by flumazenil antagonism provides a promising alternative to propofol for geriatric patients, particularly during gastrointestinal endoscopy.

Keywords: remimazolam, propofol, recovery time, gastrointestinal endoscopy, elderly patients

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