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Efficacy and safety of remimazolam in bronchoscopic sedation:A meta-analysis

World Journal of Clinical Cases 2024年第6期12卷 1120-1129页

作者： Ying Zhou Cheng Zhao Yi-Xun Tang Ji-Tong Liu Department of Anesthesiology The First Affiliated Hospital of Hunan Normal University(Hunan Provincial People’s Hospital)Changsha 410005Hunan ProvinceChina Department of Anesthesiology Zhangjiajie People's HospitalZhangjiajie 427000Hunan ProvinceChina

BACKGROUND Remimazolam is a new benzodiazepine used for procedural sedation and general anesthesia.Several studies have used remimazolam for bendable bronchoscopy.AIM To assess the safety and efficacy of remimazolam for sedation in patients undergoing bendable bronchoscopy by performing a meta-analysis of randomized controlled trials(RCTs).METHODS We searched the EMBASE,PubMed,Cochrane Library,and Web of Science databases for RCTs on bendable bronchoscopic procedural sedation with remimazolam vs conventional sedatives(CS).RESULTS Five studies with 1080 cases were included.Remimazolam had the same sedation success rate compared with CS[relative risk(RR):1.35,95%CI:0.60-3.05,P=0.474,I2=99.6%].However,remimazolam was associated with a lower incidence of hypotension(RR:0.61;95%CI:0.40-0.95,P=0.027;I2=65.1%)and a lower incidence of respiratory depression(RR:0.50,95%CI:0.33-0.77,P=0.002,I2=42.3%).A subgroup analysis showed a higher success rate of sedation with remimazolam than midazolam(RR:2.45,95%CI:1.76-3.42,Psedation success rate was similar to that in the CS group.However,remimazolam has a higher safety profile,with fewer inhibitory effects on respiration and circulation.

关键词： Remimazolam Bronchoscopy procedural sedation Meta-analysis

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Emergency department procedural sedation for primary electrical cardioversion — a comparison with procedural sedations for other reasons

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World Journal of Emergency Medicine 2017年第3期8卷 165-169页

作者： Michael Butler Patrick Froese Peter Zed George Kovacs Robert Mac Kinley Kirk Magee Mary-Lynn Watson Samuel G.Campbell Department of Emergency Medicine Faculty of Medicine Dalhousie University Department of Undergraduate Medicine Faculty of Medicine Dalhousie University Faculty of Pharmaceutical Sciences University of British Columbia Department of Emergency Medicine Faculty of Medicine University of British Columbia

BACKGROUND: Atrial fibrillation(AF) is the most common arrhythmia treated in the emergency department(ED), with primary electrical cardioversion(PEC) the preferred method of rhythm control. Anecdotally, patients undergoing ED procedural sedation(EDPS) for PEC differ from those requiring EDPS for other procedures: they are at higher risk of adverse events, and require fewer drugs and lower doses. We attempt to verify this using an EDPS registry at a Canadian, tertiary care teaching hospital.METHODS: This is a retrospective review of patients that underwent EDPS for the period of June 2006 to September 2014. We compared demographics, medication use and intra-procedural adverse events between those receiving EDPS for PEC for AF compared to that for other indications. We report the asssociation between AEs and predictors using logistic regression.RESULTS: A total of 4 867 patients were included, 714 for PEC for AF and 4 153 for other indications. PEC patients were more likely male(58.5% vs. 47.1%), older(59.5 years vs. 48.1 years), and less likely to be ASA I(46.6% vs. 69.0%). PEC patients received smaller doses of propofol and less likely to receive adjuvant analgesic therapy(11.5% vs. 78.2%). PEC patients were more likely to experience hypotension(27.6% vs. 16.5%) but respiratory AEs(apnea, hypoxia and airway intervention) were not different.CONCLUSION: EDPS for PEC differs from that conducted for other purposes: patients tend to be less healthy, receive smaller doses of medication and more likely to suffer hypotension without an increase in respiratory AEs. These factors should be considered when performing EDPS.

关键词： procedural sedation Atrial fibrillation Electrical cardioversion

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Impact of the United States propofol ban on emergency providers' procedural sedation agent choice and patient length of stay

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World Journal of Emergency Medicine 2012年第3期3卷 177-181页

作者： Jonathan Pester Joseph Robinson John Prestosh Suzanne Roozendaal Rebecca Jeanmonod St.Luke's University Hospital and Health Network BethlehemPA 18015USA

BACKGROUND:In the recent past,propofol was temporarily removed from the emergency department(ED) for use in procedural sedation.We sought to determine which agents replaced it in clinical practice and the impact this change had on turnaround times(TAT) for sedated patients.METHODS:This study is a retrospective chart review at a level one trauma center.Patients receiving sedative agents(propofol,ketamine,midazolam,and etomidate) were identified by pharmacy codes,and their charts were then reviewed for demographics and TAT.Propofol was unavailable in the emergency department(ED) between May 2010 and February 2011.The study period extended from May 2009 until May 2011.Patients receiving sedation by non-emergency medicine physicians and those receiving sedation related to intubation were excluded.RESULTS:In total 2466 charts were reviewed and 209 met inclusion criteria.When propofol was available,the most commonly used sedative agent was etomidate(40%),followed by propofol(28%),ketamine(20%),and midazolam(6%).When propofol was unavailable,etomidate remained the most commonly used agent(43%),followed by ketamine(41%),and midazolam(11%).When propofol was available,the median TAT for sedated patients was 163 minutes compared to 178 minutes when propofol was unavailable(P=0.83).When propofol was the primary sedative agent used,the median TAT was 166 minutes as compared with a median TAT of 172 minutes for all other sedative agents combined(P=0.87).CONCLUSION:When propofol was unavailable,ketamine became a preferred ED sedation agent.Removal of propofol from the sedation armamentarium did not affect ED TAT.

关键词： procedural sedation Turnaround time Propofol Ketamine Etomidate Midazolam

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sedation and analgesia in children with cerebral palsy:a narrative review

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World Journal of Pediatrics 2019年第5期15卷 432-440页

作者： Ingrid Rabach Francesca Peri Marta Minute Emanuela Aru Marianna Lucafò Alberto Di Mascio Giorgio Cozzi Egidio Barbi Institute for Maternal and Child Health IRCCS'Burlo Garofolo'Via dell'Istria 65/134100 TriesteItaly University of Trieste TriesteItaly Department of Medicine Surgery and Health SciencesUniversity of TriesteTriesteItaly

Background Patients with cognitive impairment due to cerebral palsy experience pain more often than healthy peers and frequently require diagnostic and therapeutic painful procedures.Analgesia and procedural sedation outside the operating room are often required,but they may not adequately be provided because of the inability to accurately recognize and classify the state of pain and for the perceived higher risk of complications.Data sources We reviewed the available literature to highlight the specific risk factors and area of criticism,that should be further improved.We searched the Cochrane Library,Medline,Pubmed from 1987 to September 2018 using key words such as'cerebral palsy and children and pain'or'sedation and cerebral palsy and children'.Results While different pain scales are useful in recognizing pain expressions,anxiety scales are not available.Moreover,studies on non-pharmacological techniques do not always have comparable results.Several risk factors,from anatomic abnormalities to liver and kidney functioning,should be kept in mind before proceeding with sedation.Conclusions Large trials are needed to assess the impact of non-pharmacological techniques and to evaluate which pain control strategy(pharmacological and non-pharmacological)should be used in different settings.

关键词： Analgesia Cerebral palsy Intellectual disability Pain procedural sedation

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