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Randomized Controlled Trial
. 2025 Apr 7;30(1):250.
doi: 10.1186/s40001-025-02519-1.

Comparison of effect of remimazolam and propofol on respiration of patients under deep sedation for colonoscopy: a prospective multicenter randomized controlled trial

Zhengjia Wang #  1 , Renshu Zhan #  1 , Liqun Mo  1   2 , Jin Zhang  3 , Jie Hu  4 , Shoupeng Tan  5 , Qiongzhen He  6 , Ping Li  7 , Wekong Sun  8 , Xiaobin Wang  1   2 , Jun Jiang  9 , Li Liu  1   2 , Yingying Zhang  1   2 , Yiping Bai  10   11
Affiliations
Randomized Controlled Trial

Comparison of effect of remimazolam and propofol on respiration of patients under deep sedation for colonoscopy: a prospective multicenter randomized controlled trial

Zhengjia Wang et al. Eur J Med Res. .

Abstract

Background: Remimazolam recently became available as a sedative. The comparison of the respiratory suppression effects of remimazolam and propofol under deep sedation for colonoscopy was not thoroughly unclear, particularly with regard to the novel metric of time to first airway intervention. The goal of this study was to systemically compare the respiration profiles of the patients sedated with remimazolam and propofol at the comparable sedation level in the patients undergoing colonoscopy.

Methods: Four hundred-fifty outpatients were randomly assigned to remimazolam (Group Rem, n = 225) and propofol (Group Pro, n = 225). The target sedation level was the modified Observer's Assessment of Alertness/Sedation ≤ 2. The primary outcome was elapsed time from anesthesia induction to first airway intervention. Secondary outcomes included incidence and severity of hypoxia and apnea, minute ventilation (MV), tidal volume (TV), and respiratory rate (RR).

Results: The elapsed time from induction to the first airway intervention was 11 ± 8 min in Group Rem (n = 208) vs. 5 ± 6 min in Group Pro (n = 208, P < 0.001). Patients in Group Rem required less frequent airway intervention and had a lower incidence of and shorter duration of apnea than patients in Group Pro (all P < 0.001). MV at 1 min, 2 min, 4 min post-induction, and at the end of the procedure were higher in Group Rem than those in Group Pro (P < 0.001).

Conclusions: Patients sedated with remimazolam vs. propofol during colonoscopy maintain improved respiration and require less frequent airway intervention, and have lower incidence of adverse events. Clinical trial registration and registry URL ChiCTR2000034527, registered at www.chictr.org.cn.

Keywords: Anesthesia; Colonoscopy; Remimazolam; Sedation; Ventilation.

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Conflict of interest statement

Declarations. Ethical approval and consent to participate: This prospective, multicenter, randomized, single-blind study was approved by the Institutional Review Board of Affiliated Hospital of Southwest Medical University (KY2020090), and written informed consent was obtained from all subjects participating in the trial. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Subjects enrollment and randomization. Patients in the Group Rem received remimazolam for deep sedation, and in the Group Pro, patients were given propofol
Fig. 2
Fig. 2
Respiratory measurements at six-time points. Min ventilation (MV, a), tidal volume (TV, c), and respiratory rate (RR, e) were recorded at the time points before anesthesia induction (baseline), 1, 2, 4, and 6 min after induction, and at the end of the procedure. Post-induction/baseline was the ratio of six time points to baseline values. Values were expressed as the mean ± SD, *P < 0.05, **P < 0.001
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References

    1. Keswani RN, Crockett SD, Calderwood AH. AGA clinical practice update on strategies to improve quality of screening and surveillance colonoscopy: expert review. Gastroenterology. 2021;161(2):701–11. - PubMed
    1. Yang YL, Li SS, Wang XB, Li JN. Painless colonoscopy: a pilot study of a 5.9-mm endoscope for routine colonoscopy. Chin Med J. 2018;131(7):857–8. - PMC - PubMed
    1. Steenholdt C, Jensen JT, Brynskov J, Møller AM, Limschou AC, Konge L, Vilmann P. Patient satisfaction of propofol versus midazolam and fentanyl sedation during colonoscopy in inflammatory bowel disease. Clin Gastroenterol Hepatol. 2022;20(3):559-568.e555. - PubMed
    1. Walsh CT. Propofol: milk of amnesia. Cell. 2018;175(1):10–3. - PubMed
    1. Rex DK, Bhandari R, Desta T, DeMicco MP, Schaeffer C, Etzkorn K, Barish CF, Pruitt R, Cash BD, Quirk D, et al. A phase III study evaluating the efficacy and safety of remimazolam (CNS 7056) compared with placebo and midazolam in patients undergoing colonoscopy. Gastrointest Endosc. 2018;88(3):427-437.e426. - PubMed

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