Safety and Efficacy of Remimazolam Combined with Esketamine for Anesthesia in Elderly Patients Undergoing ERCP: A Randomized Controlled Trial

Comparative study on the efficacy and safety of remimazolam versus midazolam for sedation during ERCP-related procedures in the elderly.

Remimazolam significantly shortened recovery time and reduced flumazenil use in elderly patients, which may reduce staff workload after ERCP; larger studies are needed to establish comparative safety.

Up-and-Down Sequential Allocation Study Comparing the Median Effective Dose of Remimazolam Versus Propofol for Inducing Unconsciousness in Pediatric Patients.

BACKGROUND Remimazolam is a novel ultra-short-acting benzodiazepine used for general anesthesia. Compared with propofol, it offers reversibility with flumazenil and lacks injection pain. However, its optimal bolus dose for anesthesia induction in pediatric patients remains unclear. The aim of this study was to determine the effective dose of remimazolam for loss of consciousness during anesthesia induction in children aged 2 to 14 years. METHODS A prospective, randomized, controlled trial using the Dixon up-and-down sequential design was conducted. It comprised two separate, parallel dose-finding studies, in which a total of fifty children undergoing elective surgery were randomly allocated to receive either remimazolam or propofol for anesthesia induction, respectively. The primary outcome was the ED50 and ED95 of each drug. Secondary outcomes included bispectral index (BIS) values, hemodynamic changes, and adverse events within 5 min after drug administration. RESULTS The ED50 and ED95 of remimazolam were 0.17 mg/kg (95% CI 0.16-0.19) and 0.26 mg/kg (95% CI 0.23-0.29). Both drugs effectively reduced BIS values, with a significant group-time interaction. Heart rate was more stable in the remimazolam group. No respiratory depression, hypotension, or other serious adverse events were observed in either group. CONCLUSION Using a sequential up-and-down design, this study provides the first determination of the ED50 (0.17 mg/kg) of a single intravenous bolus of remimazolam for inducing loss of consciousness in pediatric patients aged 2-14 years. These findings offer a practical dosing reference for remimazolam induction in children. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR 2200067112.

EFFICACY OF DEXMEDETOMIDINE VERSUS MIDAZOLAM FOR SEDATION IN PATIENTS UNDERGOING REGIONAL ANESTHESIA: A RANDOMIZED CONTROLLED STUDY

Objectives: The objective of the study was to assess the effectiveness and safety of dexmedetomidine versus midazolam for sedation during regional anesthesia surgery. Methods: This prospective randomized comparative interventional study was conducted in the Department of Anesthesiology at a tertiary care hospital from January 2025 to January 2026. 100 adult patients undergoing elective surgeries under regional anesthesia were randomly divided into two groups: Group D (dexmedetomidine, n=50) and Group M (midazolam, n=50). Richmond agitation sedation scale (RASS) was used to evaluate sedation. Intraoperative monitoring of hemodynamic parameters, such as mean arterial pressure and heart rate, was performed. Recovery characteristics, patient satisfaction, requirement for rescue sedation and adverse effects were also assessed. Results: The mean intraoperative RASS score was significantly lower in the Group D than in the Group M (−2.8±0.5 vs. −2.5±0.7; p=0.02). The time required to reach the target sedation level was significantly greater in Group D (9.4±2.6 min vs. 7.8±2.4 min; p=0.003). The scores of patient satisfaction with dexmedetomidine use were significantly greater than with midazolam use (8.5±1.0 vs. 7.9±1.2; p=0.01). Dexmedetomidine was associated with more adverse effects of bradycardia (p=0.08) and hypotension (p=0.46), whereas midazolam was associated with more adverse effects of excessive sedation (p=0.14) and restlessness (p=0.09). Conclusion: Dexmedetomidine and midazolam were both found to be effective sedatives for patients undergoing regional anesthetic. Dexmedetomidine was found to be a more effective sedative, well tolerated, more patient-satisfying and more stable for intraoperative hemodynamic despite its comparatively slower onset of sedation than midazolam.

Non-inferiority trial of remimazolam versus propofol for fast-track anesthesia in children undergoing percutaneous closure of atrial septal defect

Remimazolam, a new member of the benzodiazepine class, has been used as an alternative to propofol during anesthesia induction. In this study, we aimed to examine the effectiveness and safety of remimazolam compared with propofol for both the induction and maintenance of fast-track general anesthesia in children undergoing percutaneous closure of an atrial septal defect (ASD). We carried out a single-center, prospective, randomized controlled, observer-blinded, non-inferiority trial among 101 children, of whom 57 received remimazolam and 44 received propofol. All children underwent percutaneous closure of an atrial septal defect and had an American Society of Anesthesiologists (ASA) physical status of II before surgery. The primary outcome was the time to laryngeal mask airway (LMA) removal, measured in minutes. We included all 101 patients in the final analysis. Children in the remimazolam group had a significantly shorter time to LMA removal (mean difference [MD]: ‑7.97 min; 95% CI: ‑8.91 to ‑7.02; p < 0.001) and a shorter duration of hospitalization (median 5 vs. 7 days; p < 0.001) than the propofol group. The Pediatric Anesthesia Emergence Delirium (PAED) score was also lower in the remimazolam group (median 3 vs. 6; p < 0.001), indicating a reduced occurrence of postoperative emergence delirium. Fewer children in the remimazolam group required a vasopressor (26% vs. 64%). Mean arterial pressure and heart rate each showed a significant intervention-by-time interaction (their trajectories over time differed between groups), without a significant overall between-group difference in either. This study suggests that remimazolam offers advantages over propofol for fast-track anesthesia in children undergoing percutaneous ASD closure, including faster LMA removal, shorter hospitalization, and a lower incidence of postoperative emergence delirium, with a differing intraoperative mean arterial pressure trajectory and comparable overall hemodynamic stability. ChiCTR2500109737, Registration date: 24 Sep. 2025. Retrospectively registered.

Efficacy and safety of oliceridine versus sufentanil in perioperative anesthesia and analgesia: a systematic review and meta-analysis with trial sequential analysis

Clinical application of remimazolam benzenesulfonate in elderly patients undergoing laparoscopic cholecystectomy under intravenous general anesthesia

BACKGROUND Elderly patients undergoing laparoscopic cholecystectomy (LC) are more vulnerable to hemodynamic instability and anesthesia-related adverse events. Remimazolam benzenesulfonate may be a useful alternative to propofol, but comparative evidence remains limited. AIM To compare the efficacy and safety of remimazolam benzenesulfonate and propofol in elderly patients undergoing LC. METHODS A total of 120 elderly patients scheduled for LC were randomized based on random number table and opaque sealed envelopes into 2 groups (n = 60 each): A propofol control group (CG) and a remimazolam benzenesulfonate observation group (OG). Anesthesia induction was intravenous propofol (1.5 mg/kg) or remimazolam benzenesulfonate (0.2 mg/kg), and rocuronium bromide (0.6 mg/kg) and sufentanil (0.4 ug/kg) in both groups. Anesthesia maintenance included targeted intravenous infusion of the assigned sedatives with remifentanil; intermittent rocuronium was used to keep a train-of-four ratio of ≤ 0.2. The primary outcome was mean arterial pressure (MAP). Secondary outcomes: Oxygen saturation, heart rate (HR), Bispectral index (BIS), perioperative use of vasoactive drugs, Riker Sedation-Agitation Scale (RSAS), Visual Analogue Scale (VAS), Mini Mental State Examination (MMSE), and incidence of adverse reactions. RESULTS After applying the predefined inclusion and exclusion criteria, 59 patients in both groups completed the trial. Relative to the CG, the OG had a longer induction time and delayed attainment of BIS < 60 (P < 0.05). However, the OG was found to have more stable MAP and HR throughout the perioperative period, lower consumption of vasoactive agents, and fewer adverse events (P < 0.05). Post-extubation RSAS scores were also lower in the OG (P < 0.05). Postoperatively, the OG had greater MMSE scores at 6 hours and lower VAS pain scores at 1 hour and 6 hours (P < 0.05). No significant variances between groups were revealed at other time points. CONCLUSION Relative to propofol, remimazolam benzenesulfonate has more stable hemodynamics and a lower incidence of adverse reactions during total intravenous anesthesia in elderly patients undergoing LC. While remimazolam showed benefits in early postoperative recovery, cognitive function, and pain control, these benefits were lost over time.