Application Effect Of Remimazolam In Flexible Bronchoscopy Under Deep Sedation

Background:Fiberoptic bronchoscopy is an important method for the examination and treatment of respiratory diseases,and its clinical application is increasingly extensive.Although routine superficial anesthesia can reduce the cough reflex,anxiety,fear,involuntary cough and body movement often cause circulatory and respiratory abnormalities.Fiberoptic bronchoscopy under sedation can improve comfort and tolerance of patients,and it has been increasingly favored in clinical applications.Sedation with propofol and sufentanil is a common anesthesia method for bronchoscopy,but propofol has a certain inhibitory effect on the respiratory and circulatory system,which can lead to complications such as hypoxemia and hypotension.It is an urgent issue for anesthesiologists to optimize the management of sedation anesthesia,better share the airway with the operators and provide them with the best diagnosis and treatment conditions.Remimazolam tosilate is a new ultra-short-acting benzodiazepine,which has quick effect,rapid metabolism and slight influence on respiratory and circulatory system.It has been clinically proved to be safe and effective in painless gastrointestinal endoscopy.This study was designed to evaluate the efficacy and safety of remimazolam tosilate in fiberoptic bronchoscopy under deep sedation,so as to provide reference for clinical application.Objective:To evaluate the efficacy and safety of remimazolam tosilate in fiberoptic bronchoscopy under deep sedation.Methods:Ninety patients（aged 18-65 years,BMI 18-25 kg/m~2,ASA grade I-Ⅱ）who underwent fiberoptic bronchoscopy were included.The patients were divided into 2groups（n=45）by random number table method:propofol combined with sufentanil group（P group）and remimazolam tosilate combined with sufentanil group（R group）.Induction of anesthesia:slow intravenous injection of sufentanil 0.1μg/kg in advance,after one minute,patients in group P were injected with propofol（2.5 mg/kg）,and group R patients were injected with remimazolam tosilate（0.25 mg/kg）.Anesthesia maintenance:patients in group P were continuously injected with propofol(4-6 mg·kg^-1·h^-1),and group R patients were continuously injected with remimazolam tosilate(0.6-1 mg·kg^-1·h^-1).The BIS value was maintained between 40-60 during the operation.The incidence of intraoperative anesthesia-related adverse events（hypoxemia,hypotension,bradycardia）in the two groups were recorded,and the success rate of sedation,the dose and frequency of rescue sedative drugs,the dose of vasopressors,the time to wake up,the time to leave the operating room,the operation time,surgical complications,surgeon satisfaction scores were recorded and the BIS value in different time.Results:Compared with the P group,the incidences of anesthesia-related adverse events such as hypoxemia,hypotension in the R group were significantly reduced,the dosage of vasopressors was reduced,and the recovery time and the time of leaving the operating room were prolonged（P<0.05）.There was no significant difference in the incidence of bradycardia events,sedation success rate,dosage and frequency of rescue sedation,operation time,surgical complications and surgeon satisfaction score between the two groups（P>0.05）.Conclusions:In contrast to propofol,remimazolam tosilate shows less inhibition of respiration and circulation and is safe and effective for bronchoscopy under deep sedation.