Effect of remimazolam tosilate on early cognitive function in elderly patients undergoing upper gastrointestinal endoscopy

Abstract

Background and Aim Remimazolam tosilate (RT) is under evaluation as a sedative for endoscopic procedures. Herein, we aimed to evaluate safety including cognition recovery of RT administered in elderly patients undergoing upper gastrointestinal endoscopy and assess its safety dosage. Methods Ninety‐nine patients presenting for upper gastrointestinal endoscopy were randomized to receive 0.1 mg/kg RT (R1) or 0.2 mg/kg RT (R2), or propofol (P). Cognitive functions (memory, attention, and executive function) were measured via neuropsychological tests conducted before sedation and 5 min after recovery to full alertness. Adverse events were also assessed. Results There were no statistical differences between postoperative and baseline results for R1 group and P group, whereas those for R2 group revealed worsened postoperative cognitive functions (immediate recall and short delay recall) than baseline (P < 0.05). Compared with P group, Scores demonstrated worse restoration of immediate recall in R1 group, immediate recall, short‐delayed recall, and attention function in R2 group (P < 0.05). Patients in R2 group had a longer sedation time (12.09 vs 8.27 vs 8.21 min; P < 0.001) and recovery time (6.85 vs 3.82 vs 4.33 min; P < 0.001) than that in R1 group and P group. Moreover, the incidence of hypotension was 3.0% in R1 group, whereas it was 21.2% in R2 group and 48.5% in P group (P < 0.05). Conclusion The addition of 0.1 mg/kg RT as an adjunct to opiate sedation for upper gastrointestinal endoscopy not only achieves more stable perioperative hemodynamics but also achieves acceptable neuropsychiatric functions in elderly patients.

Quality of Recovery After General Anesthesia with Remimazolam in Patients’ Undergoing Urologic Surgery: A Randomized Controlled Trial Comparing Remimazolam with Propofol

“… 9 Liu also found remimazolam may worsen elderly patients’ postoperative cognitive functions in upper gastrointestinal endoscopy. 32 Like remifentanil, remimazolam, when doses at the top end of the response curve, might appear undesirable desensitization effects and rebound phenomenon once stopped, such as anxiety. 5 Cases about remimazolam tolerance have been reported in benzodiazepine long-term users.…”

Sedative effect of remimazolam combined with alfentanil in colonoscopic polypectomy: a prospective, randomized, controlled clinical trial

“…These aspects all had impacts on the time to full alert. Also, Tian et al indicated that elderly patients who received 0.2 mg/kg remimazolam took significantly longer to recover than propofol in upper gastrointestinal endoscopy [ 34 ]. Besides the age of patients, differences in the administration of remimazolam and the dosage of propofol may lead to the opposite result.…”

“…An exploratory analysis suggested more episodes of hypotension when propofol was used for sedation than remimazolam [ 36 ]. Furthermore, a series of studies have shown that remimazolam had more stable hemodynamics and a lower incidence of hypotension in multiple surgical types [ 34 , 37 – 41 ]. In our study, the incidence of hypotension was lower and a higher average MAP existed in AR groups than AP group.…”

Remimazolam: An Updated Review of a New Sedative and Anaesthetic

“…The researchers administered the sedative drugs intravenously according to the group allocations [a dose of 0.10 mg/kg (R1) or 0.20 mg/kg (R2) RT; or 1.0–1.5 mg/kg propofol]. 39 Differences in the postoperative cognitive functions, sedation times, and recovery times between the patients in the R1 and propofol groups were not statistically significant. The R2 group demonstrated worsened postoperative results than baseline upon immediate recall (−2.79±4.04 vs 1.64±3.97, P<0.001) and short-delayed recall (−0.97±1.83 vs 0.61±1.47, P=0.003).…”