Objective To compare the effects of different administration sequences of propofol and remimazolam on patients respiration, circulation, and adverse reactions during painless gastroscopy.
Methods Patients who underwent painless gastroscopy at Renmin Hospital of Wuhan University from March to June 2023 were 1 ∶ 1 randomly divided into two groups using random number table method: the Remimazolam-Propofol group (RP group) and the Propofol-Remimazolam group (PR group). After both groups of patients were administered sufentanil 0.1 ug·kg-1, patients in RP group were pre-administered remimazolam 0.15 mg·kg-1, and then followed by pump injection of propofol at an injection rate of 40 mg·kg-1·h-1; patients in PR group were pre-administered propofol 0.5 mg·kg-1, and then followed by pump injection of remimazolam at an injection rate of 3mg·kg-1·h-1. When narcotrend (NT) value <60 and observer’s assessment of alertness/sedation (OAA/ S) score was 0 in both groups, gastroscopy was started. The mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR) and pulse oxygen saturation (SpO2) were recorded before anesthesia (T0), 1 min after pre-administration (T1), 1 min after completion of anesthesia (T2), 3 min after completion of anesthesia (T3), and at the time of awakening (T4). At the same time, the anesthesia effect indicators were recorded including the dosage of remimazolam or propofol during anesthesia, anesthesia time, awakening time, discharge time, peri-examination body movement cases, assisted breathing cases and adverse reactions. A paired t-test was used to compare the two groups, and repeated measurement analysis of variance was used for the changes of vital signs in the two groups during the peri-examination period.
Results Compared with T0, the NT values of the two groups were significantly decreased at T2 and T3 after anesthesia (P<0.05), but the MAP, HR, RR and SpO2 of the two groups had no significant difference compared with T0 (P>0.05). Between the two groups at each time point, there was no statistically significant difference in MAP, HR, RR, SpO2 and NT values (P>0.05). There was no significant difference between the two groups in anesthesia effect indicators such as the dosage of remimazolam and propofol, anesthesia time, awakening time, leaving hospital time, body movement cases, assisted breathing cases, and peri-examination adverse reaction indicators, such as bradycardia, hypotension, respiratory depression, hypoxemia, nausea, vomiting, dizziness and fatigue (P>0.05), but the propofol injection pain in RP group was significantly less than that in PR group (P<0.05).
Conclusion Pre-injection of low-dose remimazolam or propofol, followed by appropriate dosage of propofol or remimazolam could obtain good anesthetic effect without obvious inhibition of respiratory and circulatory according to different administration orders. Therefore, the choice of sedation should be individualized based on the anesthesiologist's preferences, the assessment of patients' risk factors and the availability of resources.
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