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Effects of Remimazolam Dose and Bolus Injection Rate on Hiccups During Painless Colonoscopy: A Double-Blind

Yanping Lu1, Xuewei Wang2, Henjing Zou1

  • 1Department of Anesthesiology, Chengdu Integrated TCM & Western Medicine Hospital, Chengdu, 610000, People's Republic of China.

Drug Design, Development and Therapy
|May 25, 2026
PubMed
Abstract

Insights

Higher doses and slower injection rates of remimazolam (administered over 20s) reduce hiccups during colonoscopy. This combination offers optimal hiccup prevention and procedural conditions.

Area of Science:

  • Anesthesiology
  • Gastroenterology
  • Pharmacology

Background:

  • Remimazolam is a widely used sedative for procedural sedation.
  • Hiccups are a common adverse event during remimazolam sedation.
  • The impact of remimazolam dose and injection rate on hiccups is not well understood.

Purpose of the Study:

  • To investigate the independent and combined effects of remimazolam dose and injection rate on hiccup occurrence.
  • To determine optimal remimazolam administration parameters for minimizing hiccups during colonoscopy.

Main Methods:

  • Prospective, randomized, double-blind, 2×2 factorial trial.
  • Adult patients undergoing painless colonoscopy received remimazolam at 0.3 or 0.4 mg kg-1 over 10s or 20s.
  • Hiccup incidence was the primary endpoint; logistic regression analyzed dose and rate effects.

Main Results:

  • Higher remimazolam dose (0.4 mg kg-1) and slower injection (20s) independently reduced hiccup incidence.
  • No significant interaction between dose and injection rate was observed.
  • The higher dose was also linked to fewer body movements and supplemental boluses without compromising hemodynamics.

Conclusions:

  • Both higher remimazolam dose and slower injection rate reduce hiccups during colonoscopy.
  • Remimazolam 0.4 mg kg-1 over 20s provides a favorable balance for hiccup prevention, procedural success, and hemodynamic stability.
Keywords:
colonoscopyfactorial trialhiccupsinjection rateremimazolam

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