JCNRJournal of Clinical and Nursing Research2208-36852208-3693Bio-Byword Scientific Publishing Pty. Ltd.10.26689/jcnr.v8i12.9300ArticleEtomidate versus Remimazolam in Elderly Patients Undergoing Painless Gastroenteroscopyhttps://artdesignp.com/journal/JCNR/8/12/10.26689/jcnr.v8i12.9300LiuRongfang,CaiQiaoying,LuLu,YangLing,ShiSong,WangYing,ZhangXuguang20258122025-01-06Objective: To compare the hemodynamic stability of etomidate and remimazolam during painless gastroscopy and evaluate the safety of remimazolam in elderly patients undergoing gastroscopy. Methods: A total of 100 elderly patients aged 65–80 years, with American Society of Anesthesiologists (ASA) physical status I–II, who underwent painless gastrointestinal endoscopy were included in this study. The patients were randomly assigned to receive either 0.2 mg/kg of remimazolam (Group R) or 0.3 mg/kg of etomidate (E group) in combination with alfentanil for anesthesia induction. Results: The mean arterial pressure (MAP) and heart rate (HR) were significantly higher in the E group compared to Group R (P < 0.05). Ephedrine was administered more frequently in the Group R (30%) than in the Group E (10%), with a statistically significant difference (P = 0.023). The incidence of myoclonus was markedly lower in the Group R (0%) compared to the Group E (60%, P < 0.01). Conclusion: During gastroenteroscopy with alfentanil, remimazolam was associated with lower MAP and HR compared to etomidate. Patients receiving remimazolam experienced a higher incidence of post-induction hypotension. Nonetheless, the safety and efficacy of remimazolam were comparable to those of etomidate, supporting its suitability as a sedative for ASA I–II elderly patients undergoing gastrointestinal endoscopy.

Frieling T, Heise J, Kreysel C, et al., 2013, Sedation-Associated Complications in Endoscopy–Prospective Multicentre Survey of 191142 Patients. Z Gastroenterol, 51(6): 568–572. https://doi.org/10.1055/s-0032-1330441. Erratum in Z Gastroenterol, 51(6): E1.

Chen S, Wang J, Xu X, et al., 2020, The Efficacy and Safety of Remimazolam Tosylate Versus Propofol in Patients Undergoing Colonoscopy: A Multicentered, Randomized, Positive-Controlled, Phase III Clinical Trial. Am J Transl Res, 12(8): 4594–4603.

Chen X, Sang N, Song K, et al., 2020, Psychomotor Recovery Following Remimazolam-induced Sedation and the Effectiveness of Flumazenil as an Antidote. Clin Ther, 42(4): 614–624. https://doi.org/10.1016/j.clinthera.2020.02.006

Zhang X, Li S, Liu J, 2021, Efficacy and Safety of Remimazolam Besylate Versus Propofol During Hysteroscopy: Single-Centre Randomized Controlled Trial. BMC Anesthesiol, 21(1): 156. https://doi.org/10.1186/s12871-021-01373-y. Erratum in BMC Anesthesiol, 21(1): 173. https://doi.org/10.1186/s12871-021-01390-x

Doi M, Morita K, Takeda J, et al., 2020, Efficacy and Safety of Remimazolam Versus Propofol for General Anesthesia: A Multicenter, Single-Blind, Randomized, Parallel-Group, Phase IIb/III Trial. J Anesth, 34(4): 543–553. https://doi.org/10.1007/s00540-020-02788-6

Rex DK, Bhandari R, Lorch DG, et al., 2021, Safety and Efficacy of Remimazolam in High Risk Colonoscopy: A Randomized Trial. Dig Liver Dis, 53(1): 94–101. https://doi.org/10.1016/j.dld.2020.10.039

Liu J, Liu R, Meng C, et al., 2017, Propofol Decreases Etomidate-Related Myoclonus in Gastroscopy. Medicine (Baltimore), 96(26): e7212. https://doi.org/10.1097/MD.0000000000007212

Huang X, Cao H, Zhang C, et al., 2023, The Difference in Mean Arterial Pressure Induced by Remimazolam Compared to Etomidate in the Presence of Fentanyl at Tracheal Intubation: A Randomized Controlled Trial. Front Pharmacol, 14: 1143784. https://doi.org/10.3389/fphar.2023.1143784

Ebert TJ, Muzi M, Berens R, et al., 1992, Sympathetic Responses to Induction of Anesthesia in Humans with Propofol or Etomidate. Anesthesiology, 76(5): 725–733. https://doi.org/10.1097/00000542-199205000-00010

Hasegawa G, Hirata N, Yoshikawa Y, et al., 2022, Differential Effects of Remimazolam and Propofol on Heart Rate Variability During Anesthesia Induction. J Anesth, 36(2): 239–245. https://doi.org/10.1007/s00540-022-03037-8

Zhou J, Curd L, Lohmer LRL, et al., 2021, A Population Pharmacodynamic Markov Mixed-Effects Model for Determining Remimazolam-Induced Sedation When Co-Administered with Fentanyl in Procedural Sedation. Clin Transl Sci, 14(4): 1554–1565. https://doi.org/10.1111/cts.13023

Doenicke AW, Roizen MF, Kugler J, et al., 1999, Reducing Myoclonus After Etomidate. Anesthesiology, 90(1): 113–119. https://doi.org/10.1097/00000542-199901000-00017