The effective doses of remimazolam besylate in the procedural sedation of endoscopic retrograde cholangiopancreatography

Abstract

This study aimed to determine the values of the half‐effective dose (ED50) and 95% effective dose (ED95) of remimazolam besylate used in the procedural sedation of endoscopic retrograde cholangiopancreatography (ERCP). Sixty patients who fulfilled the inclusion and exclusion criteria of this study were selected. Sufentanil was administered intravenously and remimazolam besylate was administered 2 min later. ERCP treatment was feasible when the modified alertness/sedation (MOAA/S) score was ≤2. If choking or movement occurred during duodenoscope placement, it was considered as a positive reaction. The dose was increased in the next patient; otherwise, it was considered as a negative reaction, and the dose was reduced in the next patient. The ED50 and ED95 values and 95% confidence interval (CI) of remimazolam besylate were calculated by Probit regression analysis. All 60 patients completed the trial. The ED50 and ED95 values of remimazolam besylate were 0.196 and 0.239 mg/kg, respectively, for the procedural sedation of ERCP. The time of MOAA/S score ≤ 2 was (82.58 ± 21.70) s, and the mean time of awakening was (9.03 ± 5.64) min. Transient hypotension was observed in two patients without medical intervention. The ED50 and ED95 values of remimazolam besylate used in the procedural sedation of ERCP were 0.196 and 0.239 mg/kg, and the dose of the medications has definite efficacy and good safety.

ED50 and ED95 of Remimazolam Tosilate Combined with Different Doses of Fentanyl in Elderly Patients for Painless Gastroscopy

“… 24 Tan et al found that when combined with a dosage of 0.1ug/kg sufentanil, the ED50 of remimazolam besylate in the procedural sedation was 0.196 mg/kg during endoscopic retrograde cholangiopancreatography (ERCP). 25 These results are larger than the ED50 of remimazolam tosilate combined with 1 ug/kg fentanyl in our study, which may be attributed the milder stimulation of gastroscopy compared with ERCP. 26 Another reason is that elderly patients exhibit heightened sensitivity to sedative drugs and opioids.…”

Remimazolam for sedation in gastrointestinal endoscopy: A comprehensive review

“…As patients undergoing ERCP need to be in a prone to semi-prone position for a prolonged period, it causes physiological changes in hemodynamics and respiration leading to challenges in management of the respiratory tract during the procedure[ 83 ]. Hence, Remimazolam can be considered as an alternative to the traditional sedating agents such as propofol due to its lower rates of respiratory depression[ 59 , 84 ]. Tan et al [ 84 ] calculated the ED50 and ED95 of Remimazolam for adequate sedation in ERCP, which were found to be 0.196 mg/kg (95%CI: 0.187–0.206 mg/kg) and 0.239 mg/kg (95%CI: 0.221–0.297 mg/kg), respectively.…”

“…Hence, Remimazolam can be considered as an alternative to the traditional sedating agents such as propofol due to its lower rates of respiratory depression[ 59 , 84 ]. Tan et al [ 84 ] calculated the ED50 and ED95 of Remimazolam for adequate sedation in ERCP, which were found to be 0.196 mg/kg (95%CI: 0.187–0.206 mg/kg) and 0.239 mg/kg (95%CI: 0.221–0.297 mg/kg), respectively. Furthermore, as ERCP can be painful, a sedative alone is usually never sufficient in such a procedure, it is usually combined with an opioid analgesic such as sufentanil and the combination of 0.239 mg/kg of Remimazolam with a 0.1 mg/kg of sufentanil is sufficient to provide adequate sedation with analgesia for the procedure[ 84 ].…”

“…Tan et al [ 84 ] calculated the ED50 and ED95 of Remimazolam for adequate sedation in ERCP, which were found to be 0.196 mg/kg (95%CI: 0.187–0.206 mg/kg) and 0.239 mg/kg (95%CI: 0.221–0.297 mg/kg), respectively. Furthermore, as ERCP can be painful, a sedative alone is usually never sufficient in such a procedure, it is usually combined with an opioid analgesic such as sufentanil and the combination of 0.239 mg/kg of Remimazolam with a 0.1 mg/kg of sufentanil is sufficient to provide adequate sedation with analgesia for the procedure[ 84 ]. However, the patients need to be observed for positive reactions such as a cough response or body movements which may be an early indication for the need of additional sedation in some cases[ 84 ].…”

Mitochondria-mediated Ferroptosis in Diseases Therapy: From Molecular Mechanisms to Implications

“…The progression and cellular sensitivity to ferroptosis are influenced by iron metabolism, energy metabolism, lipid metabolism, and specific molecules. As our understanding of ferroptosis has advanced, it has become increasingly clear that this form of cell death is closely associated with various diseases, including cancer, cardiovascular diseases, inflammatory diseases, and others [9][10][11][12][13][14]. Moreover, targeting ferroptosis as a treatment approach has shown promise in these diseases, (fer-1) and liproxstatin-1 (lip-1) [15], as well as the use of anticancer drugs like sorafenib to modulate cancer and cardiovascular diseases through RCD mechanisms.…”