Efficacy and safety of remimazolam-based sedation for intensive care unit patients undergoing upper gastrointestinal endoscopy: a cohort study

doi:10.5847/wjem.j.1920-8642.2023.020

Abstract

Abstract:

BACKGROUND: Remimazolam is a novel ultra-short-acting sedative, but its safety and adverse events (AEs) in high-risk patients in the intensive care unit (ICU) setting remain unknown.

METHODS: This was a single-center, retrospective study that compared remimazolam to propofol and midazolam in patients undergoing upper gastrointestinal endoscopy. The primary outcome was the incidence of treatment-related AEs. The secondary outcomes were the time to extubation, the length of ICU stay, and the average cost of sedative per case.

RESULTS: Of the 88 patients analyzed, 47 were treated with remimazolam (mean dose, 7.90±4.84 mg), and 41 were treated with propofol (21.19±17.98 mg) or midazolam (3.08±2.17 mg). There was no statistically significant difference in the average duration of the endoscopic procedure (35.89±13.37 min vs. 44.51±21.68 min, P=0.133) or the time to extubation (15.00±9.75 h vs. 20.59±18.71 h, P=0.211) in the remimazolam group (group I) compared to the propofol or midazolam group (group II). ICU stays (5.40±2.93 d vs. 4.63±3.31 d, P=0.072) and treatment-related AEs (48.61% vs. 51.38%, P=0.056) were similar between groups. The average cost of sedative per case was significantly lower in the group I than in the group II (RMB 16.07±10.58 yuan vs. RMB 24.37±15.46 yuan, P=0.016).

CONCLUSION: Remimazolam-based sedation was noninferior to the classic sedatives and had lower average cost per case, indicating that it may be used as a promising sedative for high-risk patients during endoscopic procedures in the ICU setting.

Key words: Endoscopic sedation, Intensive care unit, Midazolam, Propofol, Remimazolam

Yuan-rui Zhao, Ke-sheng Huang, Guo Hou, Lan Yao, Li-ping Lu, Song Xu, Ying-tao Lian, Zhun Yao, Zhui Yu. Efficacy and safety of remimazolam-based sedation for intensive care unit patients undergoing upper gastrointestinal endoscopy: a cohort study[J]. World Journal of Emergency Medicine, 2023, 14(1): 31-36.

Figures/Tables 3

Figure 1.

Table 1.

Table 2.

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Items	Group Ⅰ (n=47)	Group Ⅱ (n=41)	P-value^*
The time between symptom onset and endoscopic procedure, h	27.76±29.32	54.04±77.84	0.346
The average duration of endoscopic procedure, min	35.89±13.37	44.51±21.68	0.133
Endotracheal intubation, n (%)	45 (95.74)	40 (97.56)	0.641
Time to extubation, h	15.00±9.75	20.59±18.71	0.211
Prolonged use of vasoactive drugs, n (%)	17 (36.17)	10 (24.39)	0.235
Diagnosis, n (%)			0.112
EGVB	23 (48.94)	27 (65.85)
PUD	24 (51.06)	14 (34.15)
Length of ICU stay, d	5.40±2.93	4.63±3.31	0.072
Average cost of sedative per case, yuan	16.07±10.58	24.37±15.46	0.016

Adverse events	Total (n=88)	Group Ⅰ (n =47)	Group Ⅱ (n =41)	P-value^*
Total AEs	72	35	37	0.056
Delirium/Dysphoria, n (%)	15 (17.04)	8 (17.02)	7 (17.07)	0.995
Nausea, n (%)	19 (21.60)	11 (23.40)	8 (19.51)	0.658
Vomiting, n (%)	24 (27.27)	12 (25.53)	12 (29.27)	0.695
Stroke, n (%)	2 (2.27)	0 (0.00)	2 (4.88)	0.214
CA, n (%)	1 (1.14)	0 (0.00)	1 (2.44)	0.466
Shock, n (%)	11 (12.50)	4 (8.51)	7 (17.07)	0.226