Patient-controlled sedation with remimazolam in outpatient colonoscopy: a feasibility pilot study

To evaluate the feasibility, safety, and patient satisfaction of patient-controlled sedation (PCS) with remimazolam during outpatient colonoscopy.

This quality improvement project was approved by the Institutional Review Board. Ten patients (median age 60.5 years, range 53-71; 50% female) underwent colonoscopy using PCS via an infusion pump (CADD-Solis). The protocol included an initial bolus of 5-7.5 mg remimazolam plus 1 mg alfentanil, followed by patient-controlled 2.5 mg boluses with a 2-minute lockout. Vital signs were continuously monitored, and adverse events were classified according to the international reporting tool on adverse events in sedation.

All procedures were completed successfully. The median total remimazolam dose was 14 mg (range 5-27.5), and median procedure time was 41 minutes (range 23-105). No serious adverse events occurred; one patient (10%) experienced brief, transient oxygen desaturation that resolved spontaneously. Hemodynamic stability was maintained throughout. Patient satisfaction was high across all domains, with median scores ranging from 4.5 to 5.0.

Remimazolam PCS appears feasible, safe, and well tolerated for colonoscopy, with high patient satisfaction. Larger studies are warranted to confirm these findings and optimize dosing strategies. .