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Efficacy and safety of remimazolam-based sedation for intensive care unit patients undergoing upper gastrointestinal
Yuan-Rui Zhao1, Ke-Sheng Huang1, Guo Hou1
1Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China.
Background:
Remimazolam is a novel ultra-short-acting sedative, but its safety and adverse events (AEs) in high-risk patients in the intensive care unit (ICU) setting remain unknown.
Methods:
This was a single-center, retrospective study that compared remimazolam to propofol and midazolam in patients undergoing upper gastrointestinal endoscopy. The primary outcome was the incidence of treatment-related AEs. The secondary outcomes were the time to extubation, the length of ICU stay, and the average cost of sedative per case.
Results:
Of the 88 patients analyzed, 47 were treated with remimazolam (mean dose, 7.90±4.84 mg), and 41 were treated with propofol (21.19±17.98 mg) or midazolam (3.08±2.17 mg). There was no statistically significant difference in the average duration of the endoscopic procedure (35.89±13.37 min vs. 44.51±21.68 min, P=0.133) or the time to extubation (15.00±9.75 h vs. 20.59±18.71 h, P=0.211) in the remimazolam group (group I) compared to the propofol or midazolam group (group II). ICU stays (5.40±2.93 d vs. 4.63±3.31 d, P=0.072) and treatment-related AEs (48.61% vs. 51.38%, P=0.056) were similar between groups. The average cost of sedative per case was significantly lower in the group I than in the group II (RMB 16.07±10.58 yuan vs. RMB 24.37±15.46 yuan, P=0.016).
Conclusion:
Remimazolam-based sedation was noninferior to the classic sedatives and had lower average cost per case, indicating that it may be used as a promising sedative for high-risk patients during endoscopic procedures in the ICU setting.
Insights
Remimazolam is a safe and effective sedative for high-risk ICU patients undergoing endoscopy. This ultra-short-acting sedative demonstrated comparable safety to propofol and midazolam, with a significantly lower cost per case.
Area of Science:
- Anesthesiology and Critical Care Medicine
- Pharmacology
- Gastroenterology
Background:
- Remimazolam is a novel ultra-short-acting sedative.
- Its safety and adverse events (AEs) in high-risk intensive care unit (ICU) patients are not well-established.
Purpose of the Study:
- To compare the safety and efficacy of remimazolam with propofol and midazolam in high-risk patients undergoing upper gastrointestinal endoscopy.
- To evaluate treatment-related AEs, time to extubation, ICU length of stay, and sedative cost.
Main Methods:
- Single-center, retrospective study.
- Compared remimazolam (n=47) to propofol or midazolam (n=41) in ICU patients undergoing upper gastrointestinal endoscopy.
- Primary outcome: incidence of treatment-related AEs. Secondary outcomes: time to extubation, ICU stay, sedative cost.
Main Results:
- No significant difference in procedure duration or time to extubation between remimazolam and control groups.
- Similar ICU stays and treatment-related AEs between groups.
- Remimazolam showed a significantly lower average cost per case.
Conclusions:
- Remimazolam-based sedation is noninferior to traditional sedatives (propofol, midazolam) for high-risk patients during endoscopic procedures.
- Remimazolam offers a promising, cost-effective alternative for sedation in the ICU setting.
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