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Effect of Remimazolam Supplementation on Propofol Requirements During Hysteroscopy: A Double-Blind, Dose-Response
Yan-Hong Zhou1, Shu-Xi Li1, Lin Li1,2
1From the Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
Background:
Propofol is commonly used for procedural sedation but may increase side effects in a dose-dependent manner. Remimazolam, an ultrashort-acting benzodiazepine, has been approved for procedural sedation but may delay awakening. This study tested the hypothesis that remimazolam as a supplement reduces effect-site propofol concentration (Ce prop ) required to suppress response to cervical dilation in patients undergoing hysteroscopy.
Methods:
One hundred and fifty patients who were scheduled for hysteroscopy were randomized to receive 0, 0.05, 0.1, 0.15, or 0.2 mg·kg -1 intravenous remimazolam, followed by a bolus of sufentanil 0.15 μg⋅kg -1 , and a target-controlled propofol infusion. The initial target Ce prop was 3.5 μg·mL -1 and was increased or decreased in subsequent patients by steps of 0.5 μg·mL -1 according to whether there was loss of response to cervical dilation in the previous patient. We used up-down sequential analysis to determine values of Ce prop that suppressed response to cervical dilation in 50% of patients (EC 50 ).
Results:
The EC 50 of propofol for suppressing response to cervical dilation was lower in patients given 0.1 mg·kg -1 (2.08 [95% confidence interval, CI, 1.88-2.28] μg·mL -1 ), 0.15 mg⋅kg -1 (1.83 [1.56-2.10] μg·mL -1 ), and 0.2 mg⋅kg -1 (1.43 [1.27-1.58] μg·mL -1 ) remimazolam than those given 0 mg⋅kg -1 (3.67 [3.49-3.86] μg·mL -1 ) or 0.05 mg⋅kg -1 (3.47 [3.28-3.67] μg·mL -1 ) remimazolam (all were P < .005). Remimazolam at doses of 0.1, 0.15, and 0.2 mg·kg -1 decreased EC 50 of propofol by 43.3% (95% CI, 41.3%-45.5%), 50.3% (48.0%-52.8%), and 61.2% (58.7%-63.8%), respectively, from baseline (remimazolam 0 mg⋅kg -1 ). Propofol consumption was lower in patients given 0.1 mg⋅kg -1 (4.15 [3.51-5.44] mg·kg -1 ), 0.15 mg⋅kg -1 (3.54 [3.16-4.46] mg·kg -1 ), and 0.2 mg⋅kg -1 (2.74 [1.73-4.01] mg·kg -1 ) remimazolam than those given 0 mg⋅kg -1 (6.09 [4.99-7.35] mg·kg -1 ) remimazolam (all were P < .005). Time to anesthesia emergence did not differ significantly among the 5 groups.
Conclusions:
For women undergoing hysteroscopic procedures, remimazolam at doses from 0.1 to 0.2 mg·kg -1 reduced the EC 50 of propofol inhibiting response to cervical dilation and the total propofol requirement. Whether the combination could improve perioperative outcomes deserves further investigation.
Insights
Adding remimazolam to propofol sedation for hysteroscopy reduced the required propofol dose. This combination therapy effectively lowered the concentration of propofol needed to suppress patient response during cervical dilation without delaying anesthesia emergence.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Propofol is a common procedural sedation agent but carries dose-dependent side effect risks.
- Remimazolam, an ultrashort-acting benzodiazepine, is approved for sedation but may prolong awakening.
- This study investigated remimazolam's potential to reduce propofol requirements during hysteroscopy.
Purpose of the Study:
- To test if remimazolam supplementation reduces the necessary effect-site propofol concentration (Ce prop) for procedural sedation.
- To determine the median effective concentration (EC 50) of propofol required to suppress response to cervical dilation when combined with varying remimazolam doses.
Main Methods:
- 150 patients undergoing hysteroscopy were randomized to receive different doses of remimazolam (0–0.2 mg·kg -1).
- A target-controlled propofol infusion was administered, with Ce prop adjusted using an up-down sequential method.
- The EC 50 of propofol for suppressing response to cervical dilation was determined.
Main Results:
- Remimazolam doses of 0.1, 0.15, and 0.2 mg·kg -1 significantly reduced the propofol EC 50 by 43.3%, 50.3%, and 61.2%, respectively.
- Propofol consumption decreased significantly with increasing remimazolam doses.
- No significant difference in time to anesthesia emergence was observed across the groups.
Conclusions:
- Remimazolam, at doses of 0.1–0.2 mg·kg -1, effectively reduces the propofol EC 50 and total propofol requirement for hysteroscopy.
- The combination of remimazolam and propofol warrants further investigation for potential improvements in perioperative outcomes.
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