Comparative Analysis of Hemodynamic Effects of Remimazolam and Propofol Combined with Esketamine in Colonoscopic Procedures in the Elderly.
Bo-Ran Deng, Yang Zhang, Zi-Feng Xie, Ding-Ding Wang, Tao Zeng, Dong-Bo Zhang, Li Huang, Qi-Yan Wang, Tu Shen, Qiao-Ling Wu
Drug Design, Development and Therapy 2024 DOI: 10.2147/DDDT.S490179 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 754 |
| Population | Elderly patients undergoing painless colonoscopies |
| Interventions | Remimazolam-esketamine Propofol-esketamine |
| Dose | 0.15 mg/kg of remimazolam and 0.3 mg/kg of esketamine; 1.5 mg/kg of propofol with 0.3 mg/kg of esketamine |
| Topics | Esketamine |
| Keywords | Elderly patients Hemodynamic effects Remimazolam Colonoscopy sedation Geriatric anesthesia Drug safety Sedative medications Hemodynamic stability |
| Citations | 18 |
| Key findings | Remimazolam combined with esketamine resulted in significantly lower incidence of hypotension (9.78%) compared to propofol combined with esketamine (23.57%) in elderly patients undergoing painless colonoscopies. |
Abstract
The debate continues over the differential impact of remimazolam vs propofol on hemodynamic stability. This study aims to elucidate the effects of a combination of remimazolam and esketamine vs propofol and esketamine on hemodynamic parameters in elderly patients undergoing painless colonoscopies. We conducted a randomized controlled trial involving 754 patients, divided equally between two treatment groups. The remimazolam-esketamine group (RE group) received 0.15 mg/kg of remimazolam and 0.3 mg/kg of esketamine. Conversely, the propofol-esketamine group (PE group) was administered 1.5 mg/kg of propofol with 0.3 mg/kg of esketamine. Primary outcomes focused on the incidence of hypotension. Secondary outcomes assessed were other hemodynamic adverse events, intraoperative blood pressure and heart rate fluctuations, usage of vasoactive agents, sedation efficacy, and additional adverse reactions. Hypotension occurred significantly less frequently in the RE group (9.78%, 95% confidence interval[CI]: 6.67-12.87%) compared to the PE group (23.57%, 95% CI: 21.22-30.52%), P<0.001. The RE group also showed lower incidences of sinus tachycardia, sinus bradycardia, and required less support from vasoactive agents (P<0.001). Additionally, the RE group experienced smaller fluctuations in blood pressure and heart rate (P<0.05). Both groups achieved a 100% sedation success rate. Notably, the RE group had a longer induction period but a quicker recovery time (P<0.001), and lower rates of respiratory depression (P=0.006) and injection pain (P<0.001). Remimazolam combined with esketamine offers superior hemodynamic stability and significantly reduces adverse event rates compared to propofol plus esketamine in elderly patients undergoing painless colonoscopies, while maintaining effective sedation.
Comparable studies
Other randomized controlled trials on esketamine, most cited first.