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Objective: To evaluate the comparative efficacy and safety of remimazolam vs. established sedatives (dexmedetomidine, propofol, midazolam) for sedation during bronchoscopy. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted according to PRISMA guidelines and Cochrane Handbook recommendations (PROSPERO CRD420251071986). Databases (EMBASE, PubMed, Scopus, Cochrane Central, Web of Science) were searched from inception to May 14, 2025. Included studies were RCTs comparing intravenous remimazolam to comparator sedatives in adults (≥18 years) undergoing bronchoscopy. Primary outcome was procedural success rate (completion without rescue sedation). Secondary outcomes included onset time, wake-up time, procedure duration, patient satisfaction, and adverse events (hypotension, hypoxemia, tachycardia, bradycardia, hypertension). Risk of bias was assessed using RoB 2. Data were pooled using random-effects models, reporting mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI). Results: 13 RCTs (n = 2,002 patients) were included. Remimazolam demonstrated: Procedural success: Significantly higher success rates vs. dexmedetomidine (OR 2.87, 95% CI [1.13-7.29], P = 0.03; I2 = 62%) and vs. midazolam (OR 3.65, 95% CI [1.40-9.49], P = 0.008; absolute rates 77.1% vs. 3.6%). Comparable success rates to propofol (OR 0.55, 95% CI [0.11-2.61], P = 0.45; rates ~98% each). Onset/Recovery: Faster onset vs. dexmedetomidine (MD -2.01 min, 95% CI [-2.08 to -1.93], P < 0.001; I2 = 0%). Shorter wake-up time vs. dexmedetomidine (MD -1.84 min, 95% CI [-3.31 to -0.37], P = 0.01) and vs. midazolam (MD -4.72 min, 95% CI [-8.05 to -1.39], P = 0.005). Comparisons with propofol were inconclusive due to heterogeneity. Safety: Significantly lower risk of hypotension vs. propofol (OR 0.35, 95% CI [0.23-0.55], P < 0.00001) and hypoxemia vs. dexmedetomidine (OR 0.41, 95% CI [0.18-0.96], P = 0.04). Significantly higher risk of tachycardia vs. dexmedetomidine (OR 3.01, 95% CI [1.37-6.60], P = 0.006). No significant safety differences vs. midazolam. Patient satisfaction was equivalent to propofol. Conclusion: Remimazolam is a highly effective and safe sedative for bronchoscopy. It offers superior procedural success and faster recovery compared to dexmedetomidine and midazolam, while matching the high success rate of propofol. Its key safety advantage is significantly reduced hypotension risk compared to propofol, making it particularly suitable for vulnerable patients. Remimazolam represents a valuable addition to sedation options for this procedure.

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Objective: This randomized controlled study aimed to explore the safety and efficacy of a fentanyl-reduced regimen combining esketamine and remimazolam for bronchoscopy in elderly patients. Methods: A total of 274 elderly patients (aged 65-85 years, ASA I-III) underwent bronchoscopy in our hospital from September 2024 to May 2025 were randomly divided into two groups: the study group (remimazolam 0.2 mg/kg + esketamine 0.3 mg/kg + fentanyl 0.5 ug/kg) and the control group (remimazolam 0.2 mg/kg + fentanyl 1.5 ug/kg). Remimazolam 0.05 mg/kg was added as needed to maintain sufficient sedation in both groups. The primary outcome was the incidence of procedure-related hypoxemia (SpO2 < 90%). Secondary outcomes included the procedural success rate, recovery metrics (time to awakening, time to discharge, and quality of recovery score), satisfaction levels (patient and endoscopist scores), and adverse events (incidences of hypotension and hypertension, degree of salivation, and body movements like coughing or limb swings). Results: The study group had a lower incidence of hypoxemia (2.19% vs 9.49%, p = 0.010) and shorter awakening time (17.47 ± 3.10 vs.19.33 ± 3.78, p < 0.001), as well as a higher QoR-15 score (138.95 ± 2.41 vs 137.38 ± 2.70, p < 0.001) compared to the control group. The incidence of hypotension was significantly lower in the study group (0.73% vs 18.25%, p < 0.001). Although the study group exhibited a significantly higher degree of salivation (p < 0.001), no aspiration occurred. There were no significant differences in sedation success rate, discharge time, patient/endoscopist satisfaction, or incidence of agitation between the two groups. Conclusion: The fentanyl-reduced regimen ensures sedation efficacy, and reduces adverse events like respiratory depression and hypotension, despite increasing salivation. It provides a safer anesthetic option for bronchoscopy in elderly patients.

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INTRODUCTION: Post-induction hypotension (PIH) is a critical concern in elderly surgical patients and is associated with adverse postoperative outcomes. This trial aims to compare the effects of propofol, etomidate and remimazolam on the incidence of PIH in older adults undergoing non-cardiac surgery. METHODS AND ANALYSIS: In this single-centre, triple-arm, randomised controlled trial, 210 patients aged ≥80 years with American Society of Anaesthesiologists physical status I-III undergoing elective non-cardiac surgery will be recruited. All patients will receive general anaesthesia with endotracheal intubation. Patients will be randomised (1:1:1) to receive propofol, remimazolam or etomidate for anaesthesia induction (n=70 per group). The primary outcome is the incidence of PIH (mean arterial pressure (MAP) <65 mm Hg for 1 min) from induction initiation to surgical skin incision. Secondary outcomes include time to successful induction, time to tracheal intubation, MAP reduction >30% from baseline, vasopressor requirements, bradycardia, injection pain, myoclonus, postoperative delirium, and cardiac, cerebral and renal complications during hospitalisation. ETHICS AND DISSEMINATION: This trial was approved by the Ethics Committee of the First Affiliated Hospital of Soochow University (Approval No. 2024-380). The results will be peer-reviewed for publication in a scientific journal. TRIAL REGISTRATION NUMBER: ChiCTR2400090800.

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Robot-assisted laparoscopic prostatectomy (RALP) is associated with hemodynamic shifts; patients on angiotensin receptor blockers (ARBs) are especially susceptible to intraoperative hypotension. We investigated whether induction with remimazolam reduces the intraoperative hypotension incidence and severity compared with propofol in this population. Herein, 112 hypertensive patients undergoing RALP who continued ARB therapy received remimazolam (0.2 mg/kg) or propofol (1-1.5 mg/kg) for anesthetic induction. The primary endpoint was hypotension occurrence (mean arterial pressure [MAP] < 65 mmHg sustained for ≥ 1 min), assessed during the entire anesthesia and 15 min post-induction. Secondary endpoints included MAP < 55 mmHg sustained for ≥ 1 min, time-weighted average (TWA)-MAP < 65 mmHg or < 55 mmHg, duration of MAP < 65 mmHg, and required norepinephrine dose. The hypotension incidence did not differ significantly between groups during the entire anesthesia (87.5% vs. 89.3%, P > 0.999). During the entire anesthesia, no significant between-group differences were observed for MAP < 55 mmHg for ≥ 1 min, TWA-MAP < 65 mmHg or < 55 mmHg, duration of MAP < 65 mmHg, and required norepinephrine dose. Similarly, no significant between-group differences were observed during the 15 min after induction. Induction with remimazolam did not reduce intraoperative hypotension risk compared with low-dose propofol in patients undergoing RALP who continued ARB therapy.Clinical trial registration number: ClinicalTrials.gov (NCT06093971, 23/10/2023).

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BACKGROUND: The objective of this study was to compare the efficacy and safety of remimazolam and dexmedetomidine in elderly patients undergoing dental implant surgery. METHODS: Seventy-four elderly patients aged 65-80 years and scheduled for dental implant surgery were randomly divided into two groups. Patients in Group R received a 0.05 mg/kg loading dose of remimazolam over 1 min and followed by an infusion rate 0.1-0.3 mg/kg/h. In Group D, a 0.5 µg/kg bolus of dexmedetomidine was given over 10 min and followed by an infusion rate 0.2-1.0 µg/kg/h. The primary outcome of the study was the incidence of hypotension between the two groups. Secondary outcomes were perioperative complications, hemodynamic and respiratory variables, sedation and recovery profiles. RESULTS: The incidence of hypotension in Group R was significantly lower than that in Group D (5.4% vs. 24.3%, RR: 0.22, 95% CI: 0.05-0.96, P = 0.022). The difference of bradycardia was not significant between Group R and Group D (2.6% vs. 13.5%, RR: 0.20, 95% CI: 0.02-1.63, P = 0.088). Only one patient in Group D experienced transient hypoxemia lasting less than 10 s. The onset of sedation was much faster in Group R than Group D (105 ± 21 s vs. 599 ± 172 s, P < 0.01). Two patients in Group D did not reach the target sedative level in 15 min after sedative infusion. All patients reached a MOAA/S score of 5 upon completion of the dental implant surgery. However, patients in Group D had a higher incidence of delayed discharge than those in Group R (16.2% vs. 2.7%, P = 0.047). CONCLUSIONS: Both remimazolam and dexmedetomidine can provide satisfactory sedation with minimal inhibition on respiratory function in elderly patients undergoing dental implant surgery. However, remimazolam is superior to dexmedetomidine, offering better hemodynamic stability, faster onset of sedation, and quicker recovery. TRIAL REGISTRATION: This study was registered at the Chinese Clinical Trials Registry (Registration ID: ChiCTR2400083062; Registration date: April 15, 2024).

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BACKGROUND: Remimazolam, a novel ultrashort-acting benzodiazepine, has been successfully used for the induction and maintenance of procedural sedation and general anesthesia. It may provide effective general anesthesia for elderly patients undergoing bronchoscopy. OBJECTIVE: To evaluate the safety and efficacy of remimazolam tosilate versus propofol in elderly patients undergoing general anesthesia for bronchoscopy. DESIGN: Prospective, single-blind, randomized clinical trial. SETTING: Single-center study conducted from November 2023 to April 2024. PATIENTS: 118 elderly patients (≥ 65 years) undergoing general anesthesia for bronchoscopy. INTERVENTIONS: Patients were randomly assigned 1:1 to receive propofol or remimazolam. MAIN OUTCOME MEASURES: The primary outcome was anesthesia success rate, defined as successful bronchoscopy completion with a Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score of 0 without rescue anesthesia. Secondary outcomes included vital signs, anesthesia characteristics, and adverse events. RESULTS: There was no significant difference in the anesthesia success rate between the two groups (P = 0.559). The onset time, MOAA/S score at extubation, hypertension, hypoxemia, tachycardia, and bradycardia were similar between the groups (P > 0.05), as were emergence agitation, nausea/vomiting, and intraoperative awareness (P > 0.05). Compared to propofol, remimazolam was associated with significantly shorter durations of hypotension, reduced injection pain, and faster awakening time (P < 0.01). CONCLUSION: Remimazolam tosilate demonstrated non-inferior safety and efficacy to propofol for general anesthesia during bronchoscopy in elderly patients. Remimazolam was associated with a lower incidence of injection pain and hypotension. Additionally, when reversed with flumazenil, remimazolam provided significantly faster recovery times compared to propofol, potentially enhancing bronchoscopy efficiency. CLINICAL TRIAL NUMBER: Clinical trial number and registry URL: ChiCTR2300076845, registration date: October 22, 2023; http://www.chictr.org.cn .

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BACKGROUND: Propofol frequently induces respiratory depression in hysteroscopy, with diaphragmatic dysfunction being a potential contributing mechanism. This study utilized ultrasound technology to investigate whether remimazolam combined with low-dose propofol can attenuate diaphragmatic dysfunction compared to propofol alone in patients undergoing hysteroscopic surgery. METHODS: Patients undergoing hysteroscopic surgery were randomized 1:1 to either remimazolam 0.2 mg/kg with propofol 1 mg/kg (RP group) or propofol 2.5 mg/kg alone (P group) for induction. Both groups received sufentanil pretreatment and propofol-remifentanil maintenance. Hemodynamic parameters (mean arterial pressure, MAP; heart rate, HR), respiratory parameters (respiratory rate, RR; pulse oxygen saturation, SpO2), and diaphragmatic parameters (diaphragmatic excursion, DE; diaphragm thickening fraction, DTF) were compared at specified timepoints: T0 (Baseline): 5 min after entering the operating room; T1: 6 min after administration of the sedative; T2: 5 min after removal of the laryngeal mask airway (LMA); T3: 5 min before discharge from the post-anesthesia care unit (PACU). Adverse reactions, including respiratory/diaphragmatic depression, injection pain, hypotension, and hiccups, were also compared. RESULTS: Eighty patients completed the final analysis. The RP group showed significantly higher DTF values compared to the P group at T1, T2, and T3 (P = 0.02; P < 0.001; P = 0.030). Additionally, the RP group had a significantly lower incidence of diaphragm dysfunction (P = 0.007), injection pain (P = 0.043), and hypotension (P = 0.048) compared to the P group. Notably, the RP group had a significantly higher rate of spontaneous (assisted) breathing compared to the P group (P = 0.011). However, the incidence of hiccups increased markedly in the RP group compared to the P group (P = 0.044). There were no statistically significant differences between the two groups in terms of respiratory depression, delayed awakening, or dizziness (P = 0.235; P = 1.000; P = 0.136). CONCLUSION: Compared to propofol, the combination of remimazolam and low-dose propofol can significantly alleviate diaphragmatic dysafunction in patients undergoing hysteroscopic surgery, while preserving spontaneous breathing more effectively. Optimized therapeutic regimens may prevent respiratory complications and accelerate recovery. TRIAL REGISTRATION: Chinese Clinical Trial Registry, identifier: ChiCTR2500102592, Date: 16/5/2025.

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The use of benzodiazepines (BZD) in the geriatric population represents a significant public health concern due to their high prevalence and associated risks. We present the case of an eighty-five-year-old patient illustrating the consequences of polypharmacy and inappropriate prescribing, including the concurrent use of multiple BZDs. This case highlights the need to limit BZD use in older adults and to prioritize evidence-based deprescribing strategies. Robust evidence confirms that BZD use increases the risk of adverse events, compromising functional independence and quality of life in older adults. Strengthening healthcare professionals' training in rational and appropriate prescribing is essential.

El uso de benzodiacepinas (BZD) en la población geriátrica constituye un problema de Salud Pública debido a su alta frecuencia y los riesgos asociados. Presentamos el caso de una paciente de ochenta y cinco años que ilustra las consecuencias de la polifarmacia y la prescripción inadecuada, incluyendo el uso de múltiples BZD. Subrayamos la necesidad de limitar el uso de BZD en adultos mayores y priorizar estrategias de retirada basadas en evidencia. Existe información amplia y contundente confirmando que el uso de BZD aumenta el riesgo de eventos adversos, comprometiendo la independencia funcional y la calidad de vida de los adultos mayores. Es esencial fortalecer la formación de los profesionales de salud en la prescripción racional y adecuada de medicamentos.

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BACKGROUND: High-risk medications such as opioids and benzodiazepines are frequently prescribed in pediatric dental care, yet their prescribing patterns and associated adverse outcomes remain poorly understood. The aim of this study was to determine the extent of such prescribing to pediatric patients and factors associated with adverse outcomes. METHODS: MarketScan data for patients younger than 18 years with a dental visit from 2014 through 2019 were analyzed. High-risk medications included benzodiazepines, barbiturates, and opioids. Composite outcomes included hospitalization, emergency department visit, or urgent care visit within 7 days after the dental visit. Opioid-attributable outcomes included opioid-related overdose within 7 days or persistent opioid use 4 through 365 days after the visit. Generalized estimating equations assessed the association between outcomes and patient and visit characteristics. RESULTS: Among pediatric dental visits, 0.72% (n = 269,991) involved high-risk medications, with 4.3% experiencing a composite outcome. Higher odds were observed in ages 9 through 11 years (odds ratio [OR], 1.56), male patients (OR, 1.05), patients with complex chronic conditions (OR, 2.22), and care delivered in hospital or ambulatory surgery settings (OR, 2.20). Among dental visits with opioids, 10.1% had an opioid-attributable outcome, with the highest odds in patients 4 through 5 years (OR, 1.48), female patients (OR, 1.08), patients with complex chronic conditions (OR, 1.22), and care delivered in outpatient clinics (OR, 1.43). CONCLUSIONS: One in 10 pediatric dental visits involving opioids was associated with opioid-related overdose or persistent use, with the highest odds in young children. These results highlight the need for caution in opioid prescribing and providing guideline-based nonopioid analgesia to children. PRACTICAL IMPLICATIONS: Promote safer, equitable pediatric dental prescribing through guideline adherence, nonopioid pain management, and provider training.

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The link between benzodiazepines (BZs) use and lung cancer remains unclear. This paper investigates this association by analyzing data from 34,084 adults, aged approximately 47.08 ±â€…0.22 years, from the National Health and Nutrition Examination Survey study conducted between 2001 and 2016. Multiple logistic regression is employed to control for various factors including age, sex, ethnicity, education, poverty to income ratio, diabetes mellitus, smoke, alcohol user, hypertension, body mass index, hyperlipidemia, chronic obstructive pulmonary disease and other cancer, in order to explore the impact of BZs on lung cancer prevalence. The findings indicate that the risk of lung cancer is 4.643 times higher in BZs users compared to nonusers (95% CI: 2.096, 10.283), and this association remains significant (OR: 2.575, 95% CI: 1.015, 6.529) after adjusting for all variables. Our research indicates that among the American population, especially men aged 60 or above, with a normal weight BMI and no hypertension, the prevalence of lung cancer is relatively high among BZs users. This requires further research to verify these findings.

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BACKGROUND: Benzodiazepine withdrawal delirium is a serious problem, and several candidates have been proposed to manage benzodiazepine withdrawal, such as valproic acid and carbamazepine, up to now. However, it is not always possible to use these candidates during the cancer perioperative period due to the risk of oversedation, and new candidates are being awaited. CASE PRESENTATION: A woman in her late 80s was prescribed lorazepam 1.0 mg/day and brotizolam 0.25 mg/day for persistent anxiety and insomnia following the death of her husband and son. She had been receiving these medications for 3 years; however, they were ineffective, and she began consuming double the prescribed dose to manage her symptoms. Additionally, problematic drinking behavior was also acknowledged. Three months before the cancer surgery, the first author and her primary physician collaborated; lorazepam was gradually reduced to 0.5 mg/day, while yokukansan (5.0 g/day) and lemborexant (5.0 mg/day) were introduced instead. Her mental status stabilized, and surgery was performed as planned with no adverse effects. Postoperative and benzodiazepine withdrawal delirium were not observed. CONCLUSION: The combination of yokukansan and lemborexant may be an effective replacement for benzodiazepines in terms of their effects on 5-hydroxytryptamine-related mechanisms and regulation of the sleep cycle. During the cancer perioperative period, physicians may consider the gradual replacement or reduction of benzodiazepines with yokukansan and lemborexant before the surgery to avoid possible benzodiazepine-related delirium.

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INTRODUCTION: The efficacy of remimazolam compared to propofol for sedation during gynaecologic procedures remains unknown, due to the increased severity of pain associated with these procedures. Therefore, a systematic review and meta-analysis was conducted to address this issue. MATERIALS AND METHODS: The protocol has been registered with PROSPERO, number CRD42024511475. Medline/PubMed, Cochrane Library, Embase, Scopus and Web of Science were searched to identify randomized controlled trials (RCTs) covering the period up to 10 January 2025. The primary outcomes comprised the success rate of sedation and the incidence of body movement. Secondary outcomes included recovery time and incidence of adverse effects (i.e. hypotension, bradycardia, respiratory depression, postoperative nausea and vomiting (PONV), dizziness, hiccup and injection pain). RESULTS: Nine RCTs (1129 patients) were included in this meta-analysis. There were no significant differences for the success rate of sedation (RR = 0.98, 95% confidence interval (CI) 0.96-1.00) or the incidence of body movement (RR = 1.03, 95% CI 0.49-2.14). Remimazolam had a lower incidence of adverse effects, including hypotension (RR = 0.21, 95% CI 0.11-0.41), bradycardia (RR = 0.12, 95% CI 0.02-0.97), respiratory depression (RR = 0.30, 95% CI 0.15-0.61), injection pain (RR = 0.06, 95% CI 0.02-0.17) and dizziness (RR = 0.29, 95% CI 0.10-0.82). However, remimazolam increased the incidence of hiccup (RR = 10.16, 95% CI 2.48-41.61). No significant differences were found regarding the recovery time (MD = 1.58, 95% CI -0.20 to 3.35) or the incidence of PONV (RR = 0.68, 95% CI 0.15-3.05). CONCLUSIONS: In gynaecologic procedures, remimazolam has comparable efficacy to propofol in the success rate of sedation and the incidence of body movement, while exhibiting superior respiratory and cardiovascular safety profiles. These findings should be cautiously generalized to other populations, and warrant further validation.

First systematic review and meta-analysis to assess the efficacy and safety of remimazolam for sedation during gynaecologic procedures.No significant differences were found in the success rate of sedation or the incidence of body movement between remimazolam and propofol for sedation during gynaecologic procedures.Remimazolam had a lower incidence of adverse effects than propofol for sedation during gynaecologic procedures.

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Aims/Background Globally, colorectal cancer ranks as the third most common malignant tumor. This study aims to evaluate and compare the effects of remimazolam versus propofol in patients undergoing surgical treatment for colorectal cancer. Methods This study retrospectively analyzed 160 patients who underwent colorectal cancer surgery from January 2023 to December 2024 at the First People's Hospital of Xiaoshan District. Seventy-five patients receiving propofol anesthesia were classified in the control group, whereas 85 patients anesthesized with remimazolam were categorized in the study group. Anesthesia index levels, recovery quality (Riker sedation-agitation scale [SAS] and confusion assessment method-Chinese revision [CAM-CR]), mean arterial pressure (MAP), heart rate (HR), adverse effects and levels of inflammatory factors, such as interleukin (IL)-6, IL-8, tumor necrosis factor alpha (TNF-α), were analyzed using chi-squared test and t-tests. Results In the study group, the time to anesthesia onset, recovery duration, length of stay in the post-anesthesia care unit (PACU), as well as the SAS and CAM-CR scores, were significantly shorter compared to those in the control group (p < 0.05). At 3 min before anesthesia (T1), there were no differences in MAP and heart rate levels between the two groups (p > 0.05). At 30 min after anesthesia (T2), immediately after surgery (T3), and 5 min after surgery (T4), the MAP of the study group exceeded those observed in the control group (p < 0.05). The incidence of adverse reactions in the study group was 10.59% (9/85), which was significantly lower than that in the control group (37.33% (28/75)) (p < 0.05). Furthermore, during the same postoperative period, levels of IL-6, IL-8, and TNF-α were found to be reduced in the study group compared to the control group (p < 0.05). Conclusion Remimazolam outperforms propofol in inducing general anesthesia for patients undergoing colorectal cancer surgery, evidenced by improvement in recovery quality and hemodynamic level, as well as reduction in the incidence of adverse effects and inflammatory level.

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BACKGROUND: Emergence agitation is common after nasal surgery under general anaesthesia. Remimazolam, a novel ultra-short-acting benzodiazepine, allows haemodynamic stability and prompt postoperative recovery, but the specific impact of remimazolam on emergence agitation is not well understood. OBJECTIVES: The primary aim of this study was to compare the effects of remimazolam-based total intravenous anaesthesia (TIVA) and sevoflurane-based volatile induction and maintenance of anaesthesia (VIMA) on the occurrence of emergence agitation. DESIGN: A prospective, randomised, assessor-blinded clinical trial. SETTING: A single-centre study in a university-affiliated tertiary hospital. PARTICIPANTS: Ninety-eight adults undergoing nasal surgery under general anaesthesia. INTERVENTIONS: Patients were randomised into two groups. The Sevoflurane group ( n  = 49) received VIMA with sevoflurane and nitrous oxide, while the Remimazolam group ( n  = 49) received TIVA with remimazolam and remifentanil. MAIN OUTCOME MEASURES: The primary outcome was the occurrence of emergence agitation, which was evaluated using the Richmond Agitation-Sedation Scale and the Riker Sedation-Agitation Scale. The secondary outcomes were immediate complications after extubation and postoperative pain, and the interval between discontinuation of anaesthesia and extubation. RESULTS: Emergence agitation, as measured by the Richmond Agitation-Sedation Scale, occurred in six of 49 patients (12.2%) in the Sevoflurane group and none (0.0%) in the Remimazolam group. The risk difference was 12.2 (95% CI, 3.0 to 21.4, P  = 0.008). The occurrence measured by the Riker Sedation-Agitation Scale was identical to that with the Richmond Agitation-Sedation Scale. Coughing was more frequent in the Sevoflurane group, 53.1 vs. 12.2%, risk difference = 40.8 (95% CI, 24.0 to 57.5, P  < 0.001). In addition, the interval between discontinuation of anaesthesia and extubation was lower in the Remimazolam group than the Sevoflurane group (9.00 ±â€Š4.25 min vs. 12.18 ±â€Š4.18 min, respectively, P <  0.001). CONCLUSION: The occurrence of emergence agitation in adult patients after nasal surgery under general anaesthesia can be significantly reduced using remimazolam-based TIVA. TRIAL REGISTRATION: Clinical Research Information Service (KCT0007387).

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OBJECTIVE: Optimizing sedation to minimize respiratory depression during fiberoptic bronchoscopy (FOB) presents an ongoing challenge. This trial compared the safety and efficacy of remimazolam-remifentanil versus propofol-remifentanil for maintaining spontaneous ventilation in patients undergoing FOB. METHODS: This pre-registered randomized controlled trial enrolled 103 consecutive candidates for FOB (April 2023 to April 2024). After excluding 10 ineligible participants, 93 were enrolled in a two-phase study. In the initial dose-determination phase, 21 participants underwent dose escalation to establish the induction dose of remimazolam (0.35 mg/kg) using the modified Dixon's method. Subsequently, 72 participants were randomly assigned in a 1:1 ratio to remimazolam-remifentanil group (Group R-R) or propofol-remifentanil group (Group P-R) (n = 36 each). Remifentanil was administered by target-controlled infusion (3.0 ng/mL plasma concentration) in both groups. Group R-R received remimazolam 0.35 mg/kg, while Group P-R received propofol 2.0 mg/kg after remifentanil loading. Standardized supplemental doses were administered for inadequate sedation (Modified Observer's Assessment of Alertness/Sedation score >1 or Bispectral index >75). The primary endpoint was the incidence of respiratory depression, defined as SpO2 <95% or a respiratory rate <8 breaths/min. Secondary outcomes included procedure completion, movement or cough-related interruptions, hemodynamic stability, adverse events, procedural time, and satisfaction ratings from both bronchoscopists and participants. RESULTS: Group R-R demonstrated a significantly lower incidence of respiratory depression (11.1% vs. 33.3%; P = 0.045) and of hypotension requiring vasopressors (16.7% vs. 41.7%; P = 0.020). However, transient involuntary movements (25.0% vs. 8.3%; P = 0.111) and cough (38.9% vs. 22.2%; P = 0.125) were numerically more frequent in Group R-R, though not statistically significant. All procedures were completed successfully without discontinuation. Hypertension, arrhythmias, procedural times, and satisfaction scores were comparable between groups (all P > 0.05). CONCLUSIONS: Compared to propofol-remifentanil, remimazolam-remifentanil provides effective moderate sedation for FOB with superior respiratory safety and reduced hypotension requiring vasopressors, despite a numerically higher incidence of transient movement and cough. It thus represents a promising alternative for maintaining spontaneous ventilation during FOB.

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ObjectiveThe sedation protocol for flexible fiberoptic bronchoscopy has long been a matter of inconclusiveness. The aim of this study was to evaluate the safety and efficacy of remimazolam combined with alfentanil in flexible fiberoptic bronchoscopy and provide insights for optimizing clinical anesthesia strategies.MethodsThis study was a randomized, single-blind controlled trial. A total of 118 patients who underwent flexible fiberoptic bronchoscopy were randomized into two groups (59 patients per group). Both groups received intravenous alfentanil 10 µg/kg 2 min before sedation treatment, followed by either 0.2 mg/kg remimazolam (Group R) or 2 mg/kg propofol (Group P). During the flexible fiberoptic bronchoscopy, the experimental drugs were administered in patients in each group as needed to maintain the depth of sedation (modified observer's assessment of alertness/sedation score ≤ 3). The primary outcome was the incidence of hypoxemia. The secondary outcomes included other safety outcomes and effectiveness outcomes.ResultsA total of 115 participants completed the study. Compared with Group P, the incidence of severe hypoxemia in Group R was lower (3.4% vs. 15.8%, P = 0.029); the incidences of injection pain and hypotension in Group R were lower (10.3% vs. 33.3%, P = 0.003); and the incidences of hypotension, dizziness, and grade of cough in Group R were lower (P < 0.05). The sedation success rate and sedation success rate at an induced dose were similar between Groups R and P (P > 0.05). Compared with Group P, sedation recovery time in Group R was shorter, and the operator comfort scores and patient comfort scores in Group R were higher (P < 0.05).ConclusionsRemimazolam, when combined with alfentanil, has shown excellent clinical potential in flexible fiberoptic bronchoscopy. Compared with propofol, it significantly reduced the incidence of severe hypoxemia, injection pain, hypotension, dizziness, and intraoperative coughing while maintaining comparable sedation success rates. It also shortened recovery time and improved both operator and patient comfort scores. These results support remimazolam plus alfentanil as a safe, effective, and well-tolerated alternative sedation regimen in this setting.

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INTRODUCTION: Older adults are increasingly involved in motor vehicle collisions (MVCs). Hypnotics are known to impair driving ability. This study investigated the prevalence of hypnotics use among older adult drivers involved in MVCs and evaluated their impact on injury severity and co-prevalence with other central nervous system (CNS) depressants. METHODS: This study analyzed prospectively collected data from older drivers (≥65 years) involved in MVCs from 2018 to 2023 across 17 Canadian emergency departments. Blood samples were tested for benzodiazepines, non-benzodiazepine hypnotics, alcohol, opioids, cannabis, stimulants, and other CNS depressants. Need for hospital admission was used as an indicator of severe injury. Statistical analyses included Chi-square tests to assess group differences and estimation of marginal relative risks via G-computation, adjusting for potential confounders. RESULTS: Among 1459 older drivers involved in collisions, 11.8% (n = 172) tested positive for hypnotics (hypnotic+). The most frequently detected agents in this group were non-benzodiazepine hypnotics (41.3%), followed by long-acting (33.7%), intermediate-acting (27.3%), and short-acting benzodiazepines (5.8%). Co-detections were also common in patients tested positive for hypnotics, particularly with antidepressants (40.1%), opioids (18.6%), antihistamines (10.5%), and antipsychotics (8.7%). Hypnotic + patients were more frequently aged 65-74 years (56.4%) and male (57.0%). There was no significant difference in risk of hospital admission between hypnotic+ and hypnotic- groups (50.0% vs. 45.8%, p = 0.59). The adjusted relative risk of admission was 1.01 [95% CI: 0.87, 1.17, p = 0.91]. CONCLUSION: Hypnotic use among older drivers involved in MVCs is prevalent and associated with polypharmacy. However, it was not associated with an increased risk of severe trauma among patients receiving ED treatment following MVCs.

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Background: Abnormal blood test results are common in both primary and specialist health care. The cause is often multifactorial, and investigations are often conducted across various specialties. We present a patient with incidental disturbances in the blood count with a serious causal relationship. Case presentation: A young man with Asperger's syndrome and epilepsy sought emergency care due to physical and mental distress following several epileptic seizures after drinking alcohol a few days prior. His physical examination was unremarkable, but blood tests showed severe neutropenia, mild anaemia and thrombocytopenia. The patient was admitted to a psychiatric ward with delusions. Interpretation: Patients with Asperger's syndrome and epilepsy are at higher risk of psychosis. On admission, the patient's delusions improved with increased olanzapine dosage, after which the medication was discontinued due to severe neutropenia. Discontinuation of olanzapine and supplementary vitamin injections did not improve the blood count. Further investigations raised suspicion of a primary bone marrow disorder. After further investigation, including a bone marrow examination, acute lymphoblastic leukaemia (ALL) was diagnosed. The case highlights the importance of thoroughly investigating serious haematologic abnormalities. It also raises questions about the potential role of long-term antiepileptic medication exposure in the development of leukaemia, which warrants further research.

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Background and Objectives: Remimazolam is a recently introduced benzodiazepine that has been increasingly adopted as an alternative to propofol. Although several trials have compared remimazolam with propofol, these studies have primarily focused on induction-related hypotension in non-gynecologic settings. To the best of our knowledge, both intraoperative hypertension and hypotension have not been systematically evaluated throughout the full anesthetic course in the specific physiologic context of robot-assisted laparoscopic gynecologic surgery performed in the steep Trendelenburg position with pneumoperitoneum. Materials and Methods: In this retrospective study, propensity score matching was performed to minimize selection bias. The demographic data of 694 patients, along with the incidence of intraoperative hypertension and hypotension, were collected through a review of medical records. Results: A total of 694 patients met the selection criteria, all of whom underwent total intravenous anesthesia (TIVA) using either remimazolam (n = 321) or propofol (n = 373). After propensity score matching, 317 pairs were analyzed. The incidence of intraoperative hypertension was higher in the remimazolam group (66.2% vs. 52.1%; p < 0.001), whereas hypotension was more frequent in the propofol group (12.0% vs. 5.4%; p = 0.003). Conclusions: TIVA with remimazolam was associated with a higher incidence of intraoperative hypertension compared to propofol, whereas propofol was more likely to cause hypotension in patients undergoing laparoscopic gynecologic surgery.

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PURPOSE: Conditioning with high-dose melphalan (MEL) followed by autologous stem cell transplantation (ASCT) is the standard treatment for multiple myeloma (MM). The optimal regimen to prevent chemotherapy-induced nausea and vomiting (CINV) is unclear. We aimed to retrospectively evaluate the antiemetic effect and safety of a four-drug intensive regimen including olanzapine (OLA) on CINV in MM patients receiving MEL/ASCT. METHODS: MEL (200 mg/m2) was administered on day 1, followed by ASCT on day 3. Patients were classified into the standard group (palonosetron and dexamethasone on day 1, and aprepitant on day 1-3), and the intensive antiemetic regimen (IAR) group (palonosetron on day 1, dexamethasone on day 1-2, and aprepitant, and OLA on day 1-5). The primary endpoint was defined as no vomiting and no rescue medications (complete response) in the delayed phase (day 2-5). RESULTS: There were no significant differences in baseline characteristics between the OLA (n = 68) and standard (n = 54) groups. The complete response rate in the IAR group was significantly higher in the delayed phase (52.9% vs. 31.4%, p < 0.05). Multivariate analysis revealed that the IAR was associated with the complete response rate (OR, 2.34; 95% CI, 1.09-5.00; p = 0.028). The incidence of nausea (grade 3) in the delayed phase was lower in the IAR group (44.1% vs. 75.9%, p < 0.001). CONCLUSION: The four-drug intensive regimen including OLA may improve the antiemetic effect on delayed CINV while also ensuring safety in MM patients undergoing MEL/ASCT.