A recent study published on trial.medpath.com reveals that using remimazolam combined with esketamine (RE) offers better hemodynamic stability than propofol combined with esketamine (PE) for elderly patients undergoing painless colonoscopies. The prospective, double-blind, randomized controlled trial, conducted at Zigong Hospital of Traditional Chinese Medicine, suggests that RE reduces the incidence of adverse hemodynamic events and provides a safer alternative for this patient population.
The study, involving 702 patients aged 65-85, compared the hemodynamic effects of RE versus PE during colonoscopies. Patients were randomized to receive either 0.15 mg/kg remimazolam plus 0.3 mg/kg esketamine or 1.5 mg/kg propofol plus 0.3 mg/kg esketamine. The primary outcome measured was the incidence of hypotension during surgery.
Key Findings
The results indicated a significantly lower incidence of intraoperative hypotension in the RE group compared to the PE group (P < 0.001). Specifically, the RE group also experienced fewer instances of intraoperative sinus tachycardia and sinus bradycardia (P < 0.001 for both). No cases of hypertension were reported in either group.
"Our findings indicate that remimazolam provides superior stability in hemodynamics compared to propofol, resulting in lower incidences of hypotension, sinus tachycardia, and sinus bradycardia," the researchers noted.
Hemodynamic Stability
Systolic and diastolic blood pressure measurements were consistently higher in the RE group between anesthesia induction (T1) and awakening (T5) (P < 0.001). While there were no significant differences at room entry (T0) and exit (T6), the intraoperative period showed a clear advantage for remimazolam in maintaining blood pressure.
Sedation Outcomes and Adverse Reactions
Both groups achieved a 100% sedation success rate. However, the induction time was longer in the RE group (P < 0.001), and they required more supplemental doses (P < 0.001). Conversely, recovery and room exit times were significantly shorter in the RE group (P < 0.001).
Injection pain was reported in the PE group but not in the RE group (P < 0.001). Respiratory depression occurred less frequently in the RE group (P = 0.006). Other adverse reactions, including blurred vision, nausea, vomiting, agitation during recovery, delirium, and hallucinations, showed no significant differences between the groups.
Clinical Implications
The study addresses a critical gap in research, as there are limited data on the use of esketamine combined with remimazolam or propofol for painless colonoscopy in the elderly. Given the unique physiological characteristics of this age group, the findings have important clinical implications.
"This regimen is recommended as an effective anesthesia strategy for painless colonoscopy procedures in elderly patients," the authors concluded. They also recommend routine administration of norepinephrine when necessary to manage hypotensive events effectively.
Limitations
The authors acknowledged several limitations, including the lack of anesthesia depth monitoring, which might have led to excessively deep anesthesia. Additionally, the study only included patients aged 65-85 with ASA grades I-II, limiting the generalizability to very elderly patients or those with higher ASA grades. Further trials are needed to validate these results in broader populations.
