Efficacy of Remimazolam Besylate and Propofol for Moderate Sedation in Elderly Patients Undergoing Painless Gastroscopy

REN Qianqian; ZHU Chengxuan; ZHANG Di; ZHANG Dongya

doi:10.3639/j.issn.2095-3097.2025.05.028

Abstract：Objective To investigate the clinical efficacy and safety of propofol and remimazolam besylate for moderate sedation in elderly patients(≥80 years)undergoing painless gastroscopy.Methods This study included 80 elderly patients who underwent painless gastroscopy at the First Affiliated Hospital of Tsinghua University between May 2023 and May 2024.Inclusion criteria comprised a Mini-Mental State Examination score≥27,body mass index 18-28 kg/m2,and American So-ciety of Anesthesiologists classification≤Ⅲ.Using a random number table,participants were allocated into two groups:the propofol group(n=40)and the remimazolam besylate group(n=40).The propofol group received an intravenous bolus of propofol(0.5 mg/kg),while the remimazolam besylate group was administered remimazolam besylate(0.1 mg/kg).Both groups received additional propofol 0.25 mg/kg or remimazolam besylate 0.05 mg/kg according to the MOAA/S score to maintain a MOAA/S score of 2-3 during the gastroscopy.Before the procedure,all patients in both groups received oral lidocaine jelly 10 ml,intra-venous sufentanil 5 μg,and tropisetron 5 mg.Heart rate(HR),mean arterial pressure(MAP),peripheral oxygen saturation,and end-tidal carbon dioxide pressure were recorded at baseline(T1),post-anesthesia induction(T2),5 minutes after procedure ini-tiation(T3),and post-procedure(T4).Sedation onset time,sedation effect score,recovery time,post-anesthesia care unit(PACU)stay duration,number of patients requiring additional medication,and sedation success rate were recorded.Adverse reactions such as hypotension,Injection pain and respiratory depression were also noted.Results Compared to the propofol group,pa-tients in the remimazolam besylate group had significantly higher HR and MAP at T2,T3,and T4.Recovery time and PACU stay duration were significantly shorter,and adverse reactions such as hypotension and injection pain were significantly reduced(P<0.05).There were no significant differences between the two groups in sedation onset time,postoperative VAS score,number of patients requiring additional medication,and sedation success rate(P>0.05).Conclusion Both propofol and remimazolam besylate demonstrated comparable safety and efficacy for moderate sedation during painless gastroscopy in elderly patients.They have a low incidence of hypoxemia under moderate sedation.Compared to the propofol group,remimazolam besylate offers superior hemodynamic stability,faster recovery,and fewer adverse events,making it preferable for high-risk elderly patients.