The Impact of Remimazolam on Hypoxemia in Elderly Patients Undergoing Flexible Bronchoscopy: A Prospective Cohort Study

Abstract

Background The elderly are at a higher risk of hypoxemia during flexible bronchoscopy due to the complexity of the procedure and the need for adequate anesthesia and sedation. This prospective cohort study aimed to estimate whether remimazolam can reduce the incidence of hypoxemia during flexible bronchoscopy in elderly patients. Methods The elderly patients who underwent fiberoptic bronchoscopy were enrolled in this prospective cohort study. We evaluated the incidence of hypoxemia during bronchoscopy with remimazolam exposed vs propofol. Exposed group patients received remimazolam 0.15mg/kg i.v followed 1mg/kg/hr. infusion, and non-exposed group patients received propofol 1mg/kg i.v followed 4-6mg/kg/hr. infusion. The incidence rates of hypoxemia, severe hypoxemia, fully alert time, and adverse effects in both groups were compared. Results In the exposed group, a hypoxemia prevalence of 29.42% was observed compared to 60.00% in the non-exposed group (OR 2.10, 95% CI 1.18–3.74, P = 0.017) prior to controlling for potential confounding variables. Similarly, the overall incidence of severe hypoxemia was 24.64%, with a lower incidence in the exposed group compared to the non-exposed group (11.76% vs. 37.14%, OR 2.10, 95% CI 1.18–3.74, P = 0.017) before adjusting for confounding factors. In either group, hypotension, bradycardia, or hypopnea were not significantly different. The incidence of hypotension was 17.65%, with a lower occurrence in the exposed group compared to the non-exposed group (17.65% vs. 37.14%, P = 0.0699), suggesting a trend towards clinical significance despite the small sample size. Remimazolam exposure exhibited a lower risk of hypoxemia in comparison to propofol (OR 0.16, 95% CI 0.04–0.64, P = 0.010). Additionally, smoking was found to be associated with a reduced risk of hypoxemia when compared to non-smoking (OR 0.008, 95% CI 0.01–0.51, P = 0.008). Conclusion This observational cohort study suggests that elderly patients undergoing FB may benefit from remimazolam sedative anesthesia, which reduces hypoxemia. Remimazolam is a safer solution than propofol for elderly patients undergoing FB. Trial registration Clinicaltrails.gov Retrospectively registered (ChiCTR2300071137 Registration date05/05, 2023)