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Effect of remimazolam on oxygen reserve compared with propofol during upper gastrointestinal endoscopy: Randomized
Kyuho Lee1, Da Hyun Jung2, Sung Jin Lee1
1Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Objectives:
Propofol is commonly used for endoscopic sedation. However, it can induce adverse hemodynamic effects. Remimazolam is known to have a fast onset and short duration comparable to that of propofol, but with fewer effects on hemodynamics. We assessed the Oxygen Reserve Index to verify whether a sedative dose of remimazolam would better preserve oxygenation in the mild hyperoxic range than propofol in sedated patients undergoing diagnostic upper gastrointestinal endoscopy.
Methods:
Patients scheduled for diagnostic upper gastrointestinal endoscopy were enrolled. Patients were randomly assigned to either the remimazolam or propofol groups and received 0.1 mg/kg remimazolam or 0.5 mg/kg propofol, respectively. Bolus injections of either 0.05 mg/kg remimazolam or 0.25 mg/kg propofol were added if required. The primary outcome was the prevalence of oxygen reserve depletion, defined as the Oxygen Reserve Index decreasing to 0.00, and hypoxia defined as peripheral oxygen saturation falling to <94%.
Results:
Among 69 patients, the incidence of oxygen reserve depletion was significantly higher in the propofol group (65.7% vs. 38.2%, P = 0.022). Hypoxia was frequently observed in the propofol group, whereas none was observed in the remimazolam group (11.4% vs. 0%, P = 0.042). Additional sedative injections were frequently required to complete endoscopy in the propofol group. None of the patients in the remimazolam group required airway interventions. Nausea was frequent in the propofol group in the recovery room.
Conclusion:
Our results indicate that remimazolam is a safe and useful sedative for upper gastrointestinal endoscopy.
Insights
Remimazolam better preserves oxygenation during endoscopy than propofol, reducing hypoxia and oxygen reserve depletion. This sedative offers a safer alternative for patients undergoing gastrointestinal procedures.
Area of Science:
- Anesthesiology
- Gastroenterology
- Critical Care Medicine
Background:
- Propofol is a common sedative for endoscopy but can cause adverse hemodynamic effects.
- Remimazolam offers rapid onset and short duration, similar to propofol, with potentially fewer hemodynamic impacts.
- The Oxygen Reserve Index (ORI) can assess oxygenation during sedation.
Purpose of the Study:
- To compare the efficacy of remimazolam versus propofol in preserving oxygenation during upper gastrointestinal endoscopy.
- To evaluate whether remimazolam better maintains oxygen reserves in mild hyperoxia compared to propofol.
- To assess the incidence of oxygen reserve depletion and hypoxia in patients sedated with either agent.
Main Methods:
- A randomized study of 69 patients undergoing diagnostic upper gastrointestinal endoscopy.
- Patients received either remimazolam (0.1 mg/kg) or propofol (0.5 mg/kg) as initial sedation.
- Oxygen Reserve Index (ORI) and peripheral oxygen saturation (SpO2) were monitored; oxygen reserve depletion (ORI=0) and hypoxia (SpO2<94%) were primary outcomes.
Main Results:
- Oxygen reserve depletion occurred significantly less often with remimazolam (38.2%) compared to propofol (65.7%).
- Hypoxia was observed in the propofol group (11.4%) but not in the remimazolam group (0%).
- Fewer additional sedative doses and airway interventions were needed with remimazolam; nausea was less frequent post-procedure.
Conclusions:
- Remimazolam demonstrates superior oxygenation preservation compared to propofol during upper gastrointestinal endoscopy.
- Remimazolam appears to be a safe and effective sedative option for endoscopic procedures.
- The findings suggest remimazolam may reduce the risk of hypoxemia and related complications in sedated patients.
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