Influence of different doses of remazolam combined with esketamine on elderly patients undergoing gastroenteroscopy

Zhang Ying; Xiao Yan; Zhang Jiao

doi:10.3969/j.issn.1672-8157.2025.03.033

Abstract：Objective To observe the impact of different doses of remazolam combined with esketamine on hemodynamics and adverse events of elderly patients undergoing gastroenteroscopy.Methods A total of 96 patients who underwent gastroenteros-copy in Meishan Second People's Hospital from October 2023 to June 2024 were enrolled in the study and randomly divided into the LR group,the MR group and the HR group,with 32 cases in each group.The patients of all the three groups were given esketamine 0.25 mg·kg-1 intravenously,while anaesthesia was induced by a combination of remazolam 0.15 mg·kg-1,0.20 mg·kg-1 and 0.25 mg·kg-1 in the LR,MR and HR groups,respectively.The haemodynamic indexes,anaesthesia-related indexes and the occurrence of adverse events were recorded and compared among the three groups.Results The mean arterial pressure and heart rate of the three groups were lower after anesthesia induction than before anesthesia and upon awakening(P<0.05).However,the mean arterial pressure and heart rate fluctuations were smaller in the MR group and HR group immediately after the placement of gastroscopy,and there was significant difference compared to the LR group(F=42.314,18.924,both P<0.05).There was no significant difference in the success rate of first sedation,onset time of anesthesia,or PACU stay time between the MR group and the HR group(P>0.05).The success rates of initial sedation(93.75%,96.88%)and PACU dwell time(20.06±3.24)min and(21.43±3.15)min of the MR and HR groups were higher than those of the LR group(75.00%,(16.37±4.80)min),respectively(χ2=8.830,Finter group=13.246,both P<0.05).The onset time of anes-thesia(34.93±4.82)s and(33.41±4.27)s of the MR group and the HR group were shorter than those of the LR group(42.15±5.64)s,respectively(Finter group=28.567,P<0.05).The incidence of adverse events was 9.38%in the MR group,lower than 53.13%in the HR group,40.63%in the LR group(χ2=14.407,P=0.001)among the patients.The gastrointestinal endoscopy examination time was similar among the three groups(P>0.05).The total dose comparison of remifentanil showed that the HR group(0.29±0.04)mg·kg-1 was higher than the MR group(0.24±0.04)mg·kg-1 and the LR group(0.19±0.05)mg·kg-1,and the MR group was higher than the LR group,with statistically significant difference(P<0.001).The incidence rates of adverse events such as body movement(12.50%)and coughing(15.61%)of the LR group were higher than those of the MR group(3.13%,0,P<0.05),and the total incidence rates of hypotension(9.38%)and hypoxemia(9.38%)of the HR group were higher than those of the MR group(3.13%,0,P<0.05),with statistically signif-icant difference.Conclusion 0.20 mg·kg-1 remazolam combined with esketamine provides better anaesthesia in geriatric gastroen-teroscopy,effectively maintains haemodynamic stability and has a high success rate of sedation,and it reduces the incidence of adverse events such as hypotension and hypoxaemia.