The effective doses of remimazolam besylate in the procedural sedation of endoscopic retrograde cholangiopancreatography

• Published in: Ibrain Vol. 9; no. 3; pp. 290 - 297
• Main Authors: Tan, Dan‐Dan, Gu, Jin, Li, Juan, Yu, Wan‐Qiu, Liu, De‐Xing, Zhao, Li‐Jin, Zhu, Guo‐Hua, Yang, Xin‐Xin, Tian, Jin, Tian, Qi, Zhu, Zhao‐Qiong
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.09.2023; John Wiley and Sons Inc; Wiley-VCH
• Subjects: Alzheimer's disease; Anesthesia; Blood pressure; Body mass index; Clinical medicine; dose finding; Drug dosages; Endoscopy; ERCP; Females; Medical diagnosis; Original; Patients; remimazolam besylate; sequential test method; Statistical analysis; Test methods; dose finding; sequential test method; ERCP; remimazolam besylate
• ISSN: 2313-1934; 2769-2795; 2769-2795
• DOI: 10.1002/ibra.12072

This study aimed to determine the values of the half‐effective dose (ED50) and 95% effective dose (ED95) of remimazolam besylate used in the procedural sedation of endoscopic retrograde cholangiopancreatography (ERCP). Sixty patients who fulfilled the inclusion and exclusion criteria of this study were selected. Sufentanil was administered intravenously and remimazolam besylate was administered 2 min later. ERCP treatment was feasible when the modified alertness/sedation (MOAA/S) score was ≤2. If choking or movement occurred during duodenoscope placement, it was considered as a positive reaction. The dose was increased in the next patient; otherwise, it was considered as a negative reaction, and the dose was reduced in the next patient. The ED50 and ED95 values and 95% confidence interval (CI) of remimazolam besylate were calculated by Probit regression analysis. All 60 patients completed the trial. The ED50 and ED95 values of remimazolam besylate were 0.196 and 0.239 mg/kg, respectively, for the procedural sedation of ERCP. The time of MOAA/S score ≤ 2 was (82.58 ± 21.70) s, and the mean time of awakening was (9.03 ± 5.64) min. Transient hypotension was observed in two patients without medical intervention. The ED50 and ED95 values of remimazolam besylate used in the procedural sedation of ERCP were 0.196 and 0.239 mg/kg, and the dose of the medications has definite efficacy and good safety. The combination of remimazolam besylate and sufentanil in endoscopic retrograde cholangiopancreatography yields a good sedative effect and only mild adverse reactions; importantly, we calculated a half‐effective dose and 95% effective dose values for remimazolam besylate. The mechanism may be related to the action of remimazolam besylate on γ‐aminobutyric acid type‐A receptors, affecting the inward flow of chloride ions.