Remimazolam Compounded With Subanesthetic Doses Of Esketamine In Painless Gastroscopy

Objective:To study the effect of remimazolam compounded with subanesthetic doses of esketamine in painless gastroscopy;to provide a new reference idea for outpatient endoscopy anesthesia.Methods:After being approved by the ethics committee of the Fourth People’s Hospital of Yunnan Province（the First Affiliated Hospital of Dali University）,150 patients who needed painless gastroscopy from January 2022 to August 2022 were selected according to the inclusion and exclusion criteria of this experiment and divided into three groups（n=50）using the envelope method in the group concealment method:the PF group（2mg/kg propofol+1ug/kg fentanyl）,the RF group（0.3mg/kg remimazolam+1ug/kg fentanyl）&RE group（0.3mg/kg remimazolam+0.25mg/kg esketamine）;the duration of each drug sedation was about1min.After sedation,the Modified observer’s assessment alert/sedation（MOAA/S）scores were assessed in the three groups,and when the MOAA/S score was<3,the surgeon started gastroscopy and maintained the MOAA/S score<3 intraoperatively.If the depth of intraoperative sedation was poor,additional propofol 0.5 mg/kg was added to the PF group and additional remimazolam 5 mg/dose was added to the RE group in the RF group to increase sedation.The main observation indexes were:heart rate（HR）,noninvasive blood pressure（MAP）,pulse oximetry（SpO₂）before anesthesia（T₀）,after drug administration（T₁）、at the time of entering the mirror（when the mirror passed the sound gate）（T₂）、at the end of operation（when the endoscopy reached the end of examination）（T₃）and at the time of awakening（T₄）in the three groups;the additional sedative drugs were recorded in the three groups number of times,atropine and ephedrine use;record the occurrence of adverse reactions during the consultation in the three groups of patients,including:injection pain,hypotension,hypoxemia,choking,body movement,dizziness,nausea and vomiting,and psychiatric symptoms;record the time of gastroscopy operation（time from entering the mirror to retiring the mirror to the incisors）,the time of awakening（from drug administration to the patient’s MOAA/S score≥4）,and the time of exit from the room in the three groups of patients（time from admission to Aldrete score≥9 after awakening）;pain scores at awakening and at exit were assessed using the Numeric rating scale（NRS）for the three groups of patients.Results:Fifty patients in each group completed the experiment.1.There were no statistically significant differences in gender、age、BMI、ASA classification、number of additional sedative drugs、number of ephedrine and atropine administration、operation time and time out of the room among the three groups（P>0.05）;2.Comparison of SpO₂、HR、and MAP at different moments in each group:1)The differences in SpO₂、HR and MAP at the moment of T₀ were not statistically significant in the three groups（P>0.05）;2)SpO₂ was significantly higher in the RE group compared with the T₀ moment,and the differences were statistically significant（P<0.05）;SpO₂ was significantly higher in the RE group compared with the PF group at T₁、T₂、T₃and T₄ moments and the differences were statistically significant（P<0.05）;SpO₂ was higher in the RE group compared with the RF group at T₁、T₂and T₃moments,and the differences were statistically significant（P<0.05）,but there was no significant change at T₄,and the difference was not statistically significant（P>0.05）;3)Compared with T₀,HR in RE group increased at T₁、T₂and T₃,and the difference was statistically significant（P<0.05）,but there was no significant difference in HR at T₄（P>0.05）;Compared with group PF,the HR of group RE at T₁、T₂、T₃ and T₄ was higher,and the difference was statistically significant（P<0.05）.Compared with the RF group,the HR of the RE group was higher at T₁、T₂and T₃,and the difference was statistically significant（P<0.05）,but there was no significant difference in HR at T₄ between the two groups（P>0.05）;4)Compared with T₀,the MAP of RE group decreased at T₄ and the difference was statistically significant（P<0.05）,but there was no significant difference in MAP at T₁、T₂ and T₃（P>0.05）.Compared with PF group,the MAP of RE group was higher at T₁、T₂、T₃ and T₄,and the difference was statistically significant（P<0.05）.Compared with the RF group,the MAP at T₁ and T₂ was higher and the difference was statistically significant（P<0.05）,but there was no significant difference in MAP between the two groups at T₃ and T₄（P>0.05）.3.The incidence of adverse reactions:there was no significant difference in the incidence of cough、body movement、nausea and vomiting、dizziness and psychiatric symptoms among the three groups（P>0.05）.The incidences of injection pain、hypotension and hypoxemia in PF group were significantly higher than those in RF group and RE group（P<0.05）.The recovery time of RE group was slower than that of PF group,the difference was statistically significant（P<0.05）,but there was no significant difference compared with RF group（P>0.05）.4.There was no significant difference in the NRS score on awakening,the NRS score on leaving the room and the PADSS score on leaving the room among the three groups（P>0.05）.Conclusion:Remimazolam（0.3mg/kg）combined with subanesthetic dose of esketamine（0.25mg/kg）can meet the needs of sedation and analgesia during painless gastroscopy,and the hemodynamics is more stable,The incidence of respiratory depression was significantly reduced,and the incidence of injection pain is significantly reduced.It does not increase the incidence of body movement,cough,nausea and vomiting,dizziness and psychiatric symptoms,and the safety is good.