The safety and efficacy of remimazolam tosylate combined with propofol in upper gastrointestinal endoscopy: A multicenter, randomized clinical trial

PLoS One. 2023 Aug 3;18(8):e0282930. doi: 10.1371/journal.pone.0282930. eCollection 2023.

Abstract

Introduction: Hypotension is the most common adverse event under propofol-mediated sedation and is possible to cause varying degrees of damage to patients. Whereas remimazolam has a poorer sedative effect than propofol.

Aim: The aim of this study was to explore the advantages of the combination of remimazolam tosylate and propofol.

Methods: 304 patients were divided into the remimazolam tosylate group (RT group), the propofol group (P group), and the remimazolam tosylate plus propofol group(R+T group). The primary outcome was the incidence of hypotension. Secondary outcomes included the results of sedation and recovery. The safety results mainly include the incidence of Hypotension, adverse respiratory events, postoperative nausea and vomiting, hiccup, cough, body movement and bradycardia.

Results: The incidence of hypotension was 56.7% in the P group, 12.6% in the RT group, and 31.3% in the R+P group, three groups of pairwise comparisons showed statistical differences, with P< 0.001. The incidence of body movement was significantly higher in the RT group (26.1%) than in the P group (10.3%) and the R+P group (12.5%), P = 0.004. The endoscopist satisfaction was higher in the P (3.87±0.44) and R+P (3.95±0.22)groups than in the RT(3.53±0.84) group. The incidence of adverse events, in descending order, was P group, RT group, and R+P group (93.8%vs.61.3%vs.42.7%).

Conclusion: Co-administration had fewer adverse events than propofol monotherapy, also had a better sedative effect and higher endoscopist satisfaction than remimazolam monotherapy.

Trial registration: Clinical trial registration number: NCT05429086.

Publication types

  • Randomized Controlled Trial
  • Multicenter Study

MeSH terms

  • Benzodiazepines / adverse effects
  • Endoscopy, Gastrointestinal / adverse effects
  • Humans
  • Hypnotics and Sedatives / adverse effects
  • Hypotension* / chemically induced
  • Propofol* / adverse effects

Substances

  • Propofol
  • remimazolam
  • Benzodiazepines
  • 4-methylbenzenesulfonic acid
  • Hypnotics and Sedatives

Associated data

  • ClinicalTrials.gov/NCT05429086

Grants and funding

The author(s) received no specific funding for this work.