Objective To compare the anesthetic effects of remimazolam and propofol in painless gastroscopy for patients with gastroesophageal varices (GEV). Methods The clinical data of 98 patients with GEV who underwent precision treatment under painless gastroscopy in Affiliated Hospital of Qingdao University between February 2022 and February 2024 were retrospectively analyzed. There were 65 males and 33 females aged 18-75 years. The patients were divided into a remimazolam group and a propofol group according to different anesthesia methods, with 49 cases in each group. After 3 minutes of intravenous anesthesia induction, the patients received either 0.2 mg/kg remimazolam or 2 mg/kg propofol accordingly. Precision gastroscopy treatment began when eyelash reflex disappeared, with intraoperative top-ups of 0.05 mg/kg remimazolam or 0.5 mg/kg propofol administered as required. Data were recorded at four time points: pre-induction baseline (T0), gastroscope passage through the pharynx (T1), 5 minutes after procedure initiation (T2), and immediately post-procedure (T3). Measured outcomes included sedation onset time, recovery time, discharge readiness time, and adverse reactions (including hiccups, dizziness, and nausea/vomiting). Results Compared with the propofol group, the remimazolam group exhibited significantly higher heart rate (HR) and mean arterial pressure (MAP) at T1, T2 and T3, and the pulse SpO2 and bispectral index (BIS) were also significantly higher at T1 and T2, with statistically significant differences (P<0.05). Compared with the propofol group, the remimazolam group showed significantly shorter recovery time[(5.39±1.12)min vs. (6.64±0.97)min] and discharge time[(19.53±3.24) min vs. (24.32± 3.76)min; P<0.05], but there was no significant difference in the onset time of sedation between the two groups. The incidence of adverse reactions in the remimazolam group was significantly lower than that in the propofol group, with statistically significant differences in the incidence of coughing and hiccups[8(16.33%) vs. 1(2.04%); 13(26.53%) vs. 1(2.04%)](P<0.05), but there was no significant difference in the incidence of bradycardia and body movement. Conclusions The application of remimazolam in the precision treatment of GEV patients under painless gastroscopy is significantly effective, with less impact on hemodynamics than propofol, and the postoperative recovery is faster.
Key words
remimazolam /
propofol /
gastroesophageal varices /
painless gastroscopy /
precision treatment
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