Effect Of Low-dose Remimazolam Combined With Propofol On Painless Gastroscopy Endoscopy Of Elderly Patients

Objective To observe the efficacy and safety of low-dose of remimazolam combined with propofol on painless gastroscopy of elderly patients.Methods The Elderly patients who underwent painless gastroscopy in Hebei General Hospital from February to July 2022 were selected.Male or female,age≥65 years old,body mass index(BMI)18-28kg/m~2.ASA grade I-II.Select research objects according to the inclusion and exclusion criteria set in this experiment.The patients were randomly divided into three groups using random number table method with 40 cases in each group:group C(propofol 1.5mg/kg).group R1(remimazolam 0.05mg/kg combined with propofol 1mg/kg).group R2(remimazolam 0.1mg/kg combined with propofol 1mg/kg).During painless gastroscopy,R1 group and R2 group were slowly injected with 0.05 and 0.1mg/kg remimazolam,respectively,and then intravenous propofol 1mg/kg.In group C,equal volume normal saline was first injected intravenously,and then propofol 1.5mg/kg was injected intravenously.The three groups were examined when the patients’modified vigilance/sedation score(MOAA/S)was 0 and the BIS value was less than 65(BIS<65 was effective).If cough,somatic reaction or BIS value was higher than 65,propofol 0.5mg/kg was added.It was defined as sedation success when no more than 3 times were added with in 15 minutes and the interval of each addition was more than 1 minutes.Record the BP,HR,Sp O2and BIS values of the patient after entering the room(T1),when the MOAA/S score is 0(T2),when the gastroscopy is placed(T3),and at the end of the examination(T4).The success rate of sedation.The dosage of propofol,the time of endoscopy,the time of awakening,the time of leaving the anesthesia recovery room,the satisfaction of patients and the satisfaction of operators were recorded.The incidence of cough,hiccup,hypotension,bradycardia,body movement reaction,hypoxemia and postoperative adverse reactions were observed and recorded.Result1.The HR,SBP,DBP and BIS values of the three groups at T2 and T3were significantly lower than T1(P<0.05).At T2 and T3,the SBP,DBP and BIS values of R1 and R2 groups were significantly higher than those of group C(P<0.05).2.Compared with group C,the total dosage of propofol in R1 and R2groups was significantly reduced(P<0.05),the time of awakening and leaving the recovery room were also significantly shortened(P<0.05),the incidence of hiccup was significantly increased(P<0.05),and the incidence of respiratory depression,somatic reaction,hypotension,choking and injection pain were significantly reduced(P<0.05).Compared with R1group,the incidence of hiccup and bucking in R2 group was significantly increased(P<0.05).Other indicators were not statistically significant.3.There was no significant difference in examination time,incidence of postoperative adverse reactions,and satisfaction of patients and doctors among the three groups.Conclusion Remimazolam combined with propofol anesthesia scheme can stabilize the hemodynamic changes,reduce the dosage of propofol,shorten the recovery time and hospital leave time,and reduce the incidence of adverse reactions.It can be safely and effectively applied to painless gastroscopy in elderly patients.Remimazolam 0.05mg/kg has a lower incidence of hiccup than 0.1mg/kg,has less impact on the operator,and the scheme is better.