Journal of anesthesia and translational medicine最新文献

{"title":"Remimazolam in anesthesia and sedation: A narrative review.","authors":"Yan Dong, Jun Ma","doi":"10.1016/j.jatmed.2025.08.002","DOIUrl":"10.1016/j.jatmed.2025.08.002","url":null,"abstract":"<p><p>Remimazolam, an innovative sedative, provides a rapid onset and quick recovery by being rapidly hydrolyzed into pharmacologically inactive CNS7054 via ubiquitous nonspecific esterases. Its pharmacokinetic characteristics (high clearance rate, small steady-state volume of distribution, short terminal half-life, and no tissue accumulation) further lay the foundation for clinical application. Compared with traditional sedative drugs, the prominent innovations of this drug are reflected in three aspects: first, it has less impact on the respiratory and circulatory systems, with stable hemodynamics and a low incidence of discomfort at the administration site; second, its sedative effect can be specifically antagonized by flumazenil, allowing for more flexible safety regulation; third, it shows excellent safety and effectiveness in special populations such as elderly patients and those with comorbid cardiovascular diseases. Clinical evidence shows that remimazolam is more effective than similar drugs in scenarios such as gastrointestinal endoscopy, operating rooms, and ICUs. Its reliable performance in special populations further supports its value as a sedative that combines innovation with clinical practicality and holds broad application prospects. This review aims to systematically elaborate on the pharmacological properties and clinical application value of remimazolam, a new benzodiazepine derivative, and provide references for its standardized use in various diagnostic and therapeutic scenarios and special populations.</p>","PeriodicalId":519929,"journal":{"name":"Journal of anesthesia and translational medicine","volume":"4 3","pages":"142-147"},"PeriodicalIF":0.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13001776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147611248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From static to dynamic: Artificial intelligence revolution in perioperative care through multimodal data fusion and closed-loop optimization.","authors":"Mingdi Xue, Jiaming Yang, Honglin Wang, Zineng Yan, Xiaoliang Chen, Weihang Gao, Rui Luo, Xiangxin Lv, Zhewei Ye","doi":"10.1016/j.jatmed.2025.06.003","DOIUrl":"10.1016/j.jatmed.2025.06.003","url":null,"abstract":"<p><p>The integration of artificial intelligence (AI) into perioperative care represents a paradigmatic transformation from static decision frameworks to dynamic, adaptive systems. This comprehensive review synthesizes recent breakthroughs in multimodal data fusion and closed-loop optimization for perioperative care, examining the convergence of technological innovation with clinical imperatives. We systematically analyze three critical dimensions: the fundamental paradigm shift driven by clinical complexity, technological breakthroughs in multimodal fusion architectures, and dynamic decision-making implementations in anesthesia depth regulation and pain management optimization. Our analysis reveals that contemporary perioperative environments demand sophisticated AI systems capable of real-time data integration and dynamic response optimization. We identify critical bottlenecks in clinical implementation, including computational optimization under real-time constraints, robustness assurance mechanisms, and interpretability challenges. Looking forward, we delineate three interconnected pillars essential for advancing the field: standardized multimodal benchmark datasets, human-AI collaborative decision-making paradigms, and ethical-regulatory frameworks. This review establishes a comprehensive roadmap for transforming perioperative care through AI integration, emphasizing the synergistic relationship between technological innovation and clinical expertise in optimizing patient outcomes.</p>","PeriodicalId":519929,"journal":{"name":"Journal of anesthesia and translational medicine","volume":"4 3","pages":"132-141"},"PeriodicalIF":0.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13001731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147611209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanism of antidepressant action of ketamine and differences between its two enantiomers.","authors":"Junbiao Zhan, Yuxi Zhang, Hao Tian, Xizi Zhu, Manlin Guo, Zhen Qiu, Zhongyuan Xia","doi":"10.1016/j.jatmed.2025.06.001","DOIUrl":"10.1016/j.jatmed.2025.06.001","url":null,"abstract":"<p><p>Ketamine has been widely used since its discovery, and in addition to its anesthetic effects, in recent years it has been found to exhibit rapid and sustained antidepressant effects in rodent models and in patients with treatment-resistant depression (TRD) at subanesthetic doses. The antidepressant mechanism of ketamine has also been intensively studied, involving glutamate receptors such as NMDAR, AMPAR, mGluR5, molecular pathways such as mTOR, ERK-CREB, PI3K/Akt, metabolites, and other related pathways such as opioid receptors, inflammation, and monoamines. Ketamine is a racemate containing equal amounts of S-ketamine and R-ketamine. S-ketamine has recently been approved by the U.S. Food and Drug Administration (FDA) as an antidepressant with a novel mechanism of action. In rodent models of depression, such as the forced swimming test (FST), the novelty suppressed feeding (NSF) test, the chronic social defeat stress (CSDS) and the learned helplessness (LH) test, R-ketamine showed more potent and prolonged antidepressant effects. Moreover, R-ketamine was free of psychotomimetic side effects and abuse tendencies, but its clinical effects are still unclear. The enantiomers of ketamine have been known to have pharmacological and clinical differences since the late 1970s and have been studied further. The exploration of the two enantiomers of ketamine for antidepressant effects may lead to a deeper understanding of new antidepressant ideas, and this review provides an overview of the mechanism of ketamine's antidepressant action in recent years as well as the differences in the effects of the two enantiomers.</p>","PeriodicalId":519929,"journal":{"name":"Journal of anesthesia and translational medicine","volume":"4 3","pages":"119-131"},"PeriodicalIF":0.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13001763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147611284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain trajectory after total knee arthroplasty (TKA) with prolonged use of outpatient adductor canal catheters.","authors":"Shane Barre, Anwar Alinani, Jose Chu Luo, Waiman Liu, Bethany Fink, Haylee Herbaugh, Sanjib Adhikary","doi":"10.1016/j.jatmed.2025.07.001","DOIUrl":"10.1016/j.jatmed.2025.07.001","url":null,"abstract":"<p><strong>Background: </strong>In this prospective observational study, we sought to evaluate whether the prolonged use of adductor canal nerve block catheters provides benefits for patients undergoing primary total knee arthroplasty.</p><p><strong>Methods: </strong>Patients aged 18 or older with an ASA score of 1-3 undergoing single primary total knee replacement were deemed eligible. After TKA procedure, adductor canal catheters were placed in the post-anesthesia care unit. Patients were followed for five consecutive days postoperatively. Inpatient data were obtained from the electronic medical record. After discharge, data were collected from daily phone calls. The main parameters were the average numeric pain score (0-10) at rest, the average numeric pain score (0-10) during and after physical therapy, and daily opioid consumption.</p><p><strong>Results: </strong>A total of 797 patients consented to take part in the study, 336 were lost to follow up, and 461 patients were included in the study. Among those with adductor canal catheters in place the average pain scores both at rest and during physical therapy decreased on Day 2 and Day 3. The average pain levels during physical therapy were significantly lower (p < 0.05) in patients with the catheter in place compared to those without, and opioid consumption was also decreased on these days.</p><p><strong>Conclusions: </strong>This study demonstrates that the prolonged use of adductor canal nerve block catheters may reduce pain and opioid consumption in patients undergoing primary TKA for up to 72 h postoperatively.</p>","PeriodicalId":519929,"journal":{"name":"Journal of anesthesia and translational medicine","volume":"4 3","pages":"114-118"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13001769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147611294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Future perspective on chronic kidney disease management.","authors":"Xiaomei Qiu, Xueqin Ding, Henry Liu, Qifang Li","doi":"10.1016/j.jatmed.2025.06.002","DOIUrl":"10.1016/j.jatmed.2025.06.002","url":null,"abstract":"<p><p>Over-activation of the sympathetic nervous system is one of the major characteristics in chronic kidney disease (CKD), with renal ischemia playing a pivotal role in its development. While various pharmacologic strategies have been introduced to suppress sympathetic activity and slow the CKD progression, these approaches are often hindered by challenges such as limited effectiveness, drug resistance, adverse effects, and poor patient adherence. Renal denervation has emerged as a potential alternative that directly targets sympathetic nerve activity, and numerous studies have highlighted its promise. However, the outcomes of renal denervation remain variable, and the procedure carries the risk of disrupting the regulatory functions of the renal nervous system. Thoracic epidural blockade presents a novel therapeutic option for CKD management by modulating sympathetic nervous system activity. This review attempts to explore the pathophysiology of CKD, the involvement of the sympathetic nervous system in disease progression, the limitations of current pharmacologic treatments and renal denervation, and the potential benefits of thoracic epidural blockade in managing CKD.</p>","PeriodicalId":519929,"journal":{"name":"Journal of anesthesia and translational medicine","volume":"4 3","pages":"109-113"},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13001739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147611258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative electroencephalography predicts postoperative nausea and vomiting in laparoscopic sleeve gastrectomy.","authors":"Chunxia Huang, Yu Zhang, Zhen Liu, Mengshu Pan, Chanjuan Chen, Juan Zhou, Shuting Xu, Shuwen He, Benli Jia, Qi Xue, Xuexiao Shao, Rui Li, Ye Zhang, Hong Chen","doi":"10.1016/j.jatmed.2025.05.003","DOIUrl":"10.1016/j.jatmed.2025.05.003","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative nausea and vomiting (PONV) is one of the most common causes for rehospitalization and emergency department visits after bariatric surgery. The current understanding of risk factors prediction for PONV remains still incomplete.</p><p><strong>Methods: </strong>A total of 64 adult patients morbidly obese patients with selective laparoscopic sleeve gastrectomy (LSG) were prospectively enrolled. Perioperative electroencephalography (EEG) information was recorded separately at different brain regions (F7, F8, Fp1, and Fp2) using the SedLine root monitor. EEG was processed into five time points corresponding to perioperative events, including anesthesia induction, tracheal intubation, skin incision, pneumoperitoneum, and gastrectomy. Group-based trajectory modeling (GBTM) was applied to identify different patterns of longitudinal trajectories of largest lyapunov exponents (LLE) indices in EEG analysis.</p><p><strong>Results: </strong>Among the 64 participants, 75 % were female, the average age was 31.5 years with a standard deviation (SD) of 5.5 years, and the average body mass index was 41.3 kg/m² with a SD of 5.0 kg/m². Nearly 60 % obese patients had a preoperative Apfel scores of 2. Two different patterns of longitudinal trajectories of LLE indices were identified as the optimal model using GBTM, which were categorized into a stable group (n = 20) and a variable group (n = 44). The incidence of PONV was significantly higher in the stable group compared to the variable group (50.0 % vs 25.0 %, <i>P</i> = 0.048). A logistic regression analysis suggested that compared to stable group, patients in the variable group had a significantly lowered risk of PONV (OR = 0.28, 95 %CI: 0.08-0.98), after adjusting for age, sex, BMI, and Apfel score.</p><p><strong>Conclusions: </strong>Perioperative EEG monitoring may help to predict PONV in morbidly obese patients with LSG. The comprehensive PONV management should consider perioperative EEG assessment.</p>","PeriodicalId":519929,"journal":{"name":"Journal of anesthesia and translational medicine","volume":"4 2","pages":"102-108"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13001735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147611227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal TREM2/PI3K/Akt signal axis elicits microglial activation and aggravates bone cancer pain.","authors":"Wenjie Wu, Mingming Han, Chengwei Yang, Zhenkun Ge, Xiang Huang, Fang Kang, Juan Li","doi":"10.1016/j.jatmed.2025.04.002","DOIUrl":"10.1016/j.jatmed.2025.04.002","url":null,"abstract":"<p><strong>Background: </strong>The TREM2 signaling pathway is activated in multiple pain conditions; nevertheless, its role in the regulation of bone cancer pain remains largely unexplored. The persistent pathological progression of bone cancer pain induces microglial overstimulation, leading to the exacerbation of spinal central inflammation. These results confound the neurobehavioral symptoms and obscure the underlying mechanisms. Thus, the precise mechanism by which TREM2 induces bone cancer pain (BCP) has yet to be clarified.</p><p><strong>Methods: </strong>Lewis lung carcinoma cells (LLC) were administered into the femoral bone marrow cavity of adult male C57BL/6J mice. Nociceptive responses were assessed utilizing von Frey and Hargreaves methods. Biochemical analysis was utilized to assess mRNA expression levels of relevant proteins and inflammatory markers in the spinal cords of the subjects, while immunofluorescence analysis was used to assess alterations in the quantity of activated microglial cells.</p><p><strong>Results: </strong>We found that the expression levels of TREM2/DAP12 genes were increased in the spinal cords of BCP mice and may influence microglial activity via activation of the PI3K/Akt signaling pathway. The intrathecal delivery of TREM2-shRNA, combined with the selective PI3K inhibitor LY2494002, significantly inhibited the overactivation of microglia in pathological states, reduced the secretion of inflammatory mediators, and consequently mitigated central neuroinflammation while reversing pain sensitization in BCP mice. Conversely, intrathecal overexpression of the TREM2 gene can also induce abnormal pain responses.</p><p><strong>Conclusion: </strong>TREM2 may be the key gene involved in the hyperalgesia induced by excessive activation of spinal microglia under pathological conditions of bone cancer, which depends on the phosphorylation of the PI3K/Akt signaling axis.</p>","PeriodicalId":519929,"journal":{"name":"Journal of anesthesia and translational medicine","volume":"4 2","pages":"91-101"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13001742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147611240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic stress contributes to long-term isoflurane anesthesia-induced cognitive dysfunction via histone acetylation modulated by RbAp48-HDAC2 in male mice.","authors":"Yuanzhen Shao, Zhiying Zheng, Chaochao Chen, Jiawen Zhou, Xin Fang, Xiangdan Gong, Tianjiao Xia","doi":"10.1016/j.jatmed.2025.04.003","DOIUrl":"10.1016/j.jatmed.2025.04.003","url":null,"abstract":"<p><strong>Background: </strong>Histone deacetylation has been shown to be related to memory decline in aging and neurodegenerative diseases. Chronic stress, which has been shown to induce histone deacetylation, is associated with cognitive impairment. In this study, we hypothesized that histone deacetylation induced by chronic stress contributes to cognitive dysfunction after long-term isoflurane anesthesia.</p><p><strong>Methods: </strong>A mouse model of 6-h isoflurane anesthesia was established. The repeated social defeat stress (RSDS) mouse model was established by repeated socialization of aggressive CD-1 mice and C57 mice. Plasma corticosterone levels were measured by ELISA assay. Cognitive function was assessed by the fear condition test. RbAp48-overexpression adenovirus was injected into the ventricles of mice and transfected into primary hippocampal neurons to enhance of RbAp48 expression. Immunofluorescence was employed to detect viral fluorescent protein expression. The expression levels of retinoblastoma-associated protein 48 (RbAp48), histone deacetylase 2(HDAC2), acetylation of H3K9 and H4K12 and brain-derived neurotrophic factor (BDNF) were detected by Western blot. Co-Immunoprecipitation (Co-IP) and Western blot were used to detect the interaction between RbAp48 and HDAC2.</p><p><strong>Results: </strong>Mice inhaling isoflurane for 6 h exhibited more severe impairment of contextual fear memory and sustained elevation of plasma corticosterone levels compared to control group mice. Notably, RSDS mice demonstrated similar behavioral and plasma corticosterone patterns post-isoflurane anesthesia compared to anesthesia group and control group mice, accompanied by decreased acetylation of H3K9 and H4K12, reduced RbAp48 expression, elevated HDAC2 levels, and enhanced RbAp48-HDAC2 interaction. Overexpression of RbAp48 effectively ameliorated these alterations both in vivo and in vitro<i>.</i> RbAp48 overexpression enhanced hippocampal BDNF expression and attenuated the contextual fear memory deficits induced by the RSDS mice following 6-h isoflurane anesthesia.</p><p><strong>Conclusions: </strong>Perioperative chronic stress exacerbates cognitive dysfunction after 6-h long-term isoflurane anesthesia. The activity of RbAp48/HDAC2-induced histone deacetylation modification plays a critical role in these negative effects on cognition.</p>","PeriodicalId":519929,"journal":{"name":"Journal of anesthesia and translational medicine","volume":"4 2","pages":"80-90"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13001762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147611297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of echocardiogram and cardiac biomarkers through three waves of COVID-19.","authors":"Yuchen Han, Grace A Long, T 'shura Ali, Kailyn Deitz, Harideep Samanapally, Vidyulata Salunkhe, Fnu Deepti, Emma C Huang, Jahnavi Sunkara, Katherine Cermack, Justin J Huang, Emilia Wang, J Tyson Davies, Maiying Kong, Jiapeng Huang","doi":"10.1016/j.jatmed.2025.05.002","DOIUrl":"10.1016/j.jatmed.2025.05.002","url":null,"abstract":"<p><strong>Background: </strong>COVID-19 has had a significant impact on the scientific field. The multitude of effects this virus has on different organ systems is a continuously expanding range of study. The purpose of this study is to differentiate between the cardiac effects of the three different waves of COVID identified between March 2020- July 2022 using echocardiographic results and the cardiac biomarkers troponin and B-type natriuretic peptide (BNP). By using this information, we can evaluate cardiac impact from COVID-19, which may lead to effects on overall survival.</p><p><strong>Methods: </strong>Information was gathered through eight acute care facilities as part of a multi-center retrospective observational cohort study of patients hospitalized with confirmed SARS-CoV-2, who experienced a cardiovascular event and received an echocardiogram during admission between March 2020 and July 2022. A total of 222 participants were included and divided into 3 waves based on the highest SARS-CoV-2 strain prevalence at the time in Louisville, KY, USA. This consisted of 56 patients in the Original wave 1 (March-July 2020), 143 during the Delta wave 2 (September 2020-March 2021), and 23 during the Omicron wave 3 (January 2022-July 2022).</p><p><strong>Results: </strong>There were statistically significant differences in cardiac functions as indicated by echocardiogram and cardiac biomarkers. The Original wave not only showed the highest intensive care unit (ICU) admission rate of 73.2 %, but it also had a notable left ventricular diastolic dysfunction and the highest BNP levels. The Delta wave had the highest troponin value of 3.1 ng/mL. The left atrial volume of patients in the Omicron wave was significantly lower than in the Original and Delta waves. However, the tricuspid annular place systolic excursion for patients in the Omicron wave was significantly higher than the other two waves. In survival time models correlated with echocardiograph parameters, the Original wave showed significant correlations between left ventricular ejection fraction, left ventricular volume, right ventricular diameter, and survival. Delta wave showed significant correlation between ascending aortic size, right ventricular systolic pressure, right atrial pressure, and survival. the Omicron wave displayed significant correlation between peak troponin levels and survival.</p><p><strong>Conclusions: </strong>COVID-19 variants showed statistically significant impacts on cardiac function and biomarkers. There were significant correaltions between these echocardiographic parameters and biomarkers with survival. These cardiac differences can be used to determine overall severity of disease and provide insight into the level of clinical care indicated in COVID patients.</p>","PeriodicalId":519929,"journal":{"name":"Journal of anesthesia and translational medicine","volume":"4 2","pages":"73-79"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12872206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146128532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of continuous infusion of remimazolam for sedation in elderly patients undergoing colonoscopic polypectomy: A non-inferiority prospective controlled clinical trial.","authors":"Zhang Tian, Tianqing Yan, Yuan Bi, Yueyang Xin, Siqi Zhou, Tiantian Chu, Aijun Xu","doi":"10.1016/j.jatmed.2025.05.001","DOIUrl":"10.1016/j.jatmed.2025.05.001","url":null,"abstract":"<p><strong>Background: </strong>To study the efficacy and safety of a bolus dose of remimazolam followed by its continuous infusion, and to identify its optimal maintenance dose in elderly patients undergoing colonoscopic polypectomy, with the aim of determining a reasonable and safe sedative and analgesic regimen for this patient population.</p><p><strong>Methods: </strong>A prospective randomized clinical trial was performed in elderly patients scheduled for colonoscopic polypectomy between January and November 2023. Eligible patients were randomly assigned into 3 groups: two experimental groups (R1 and R2), with patients given alfentanil 10 μg/kg and a bolus dose of remimazolam 6 mg/kg/h, followed by a maintenance infusion of remimazolam 0.5 mg/kg/h and 0.75 mg/kg/h, respectively, and a control group, with patients given 10 μg/kg alfentanil and 1.5 mg/kg propofol, and then 2-3 mg/kg/h propofol maintenance. The primary outcome was the sedation success rate. The secondary outcomes included vital sign changes, the bispectral index, anesthesia duration, operation duration, awakening time, and post anesthesia care unit length of stay, as well as the incidence of adverse effects.</p><p><strong>Results: </strong>A total of 126 patients were enrolled in the study, with 40, 38, and 41 patients placed in the control (P), R1, and R2 groups, respectively. The baseline characteristics of the patients were comparable among the three groups. The sedation success rate was 100 % in all three groups (95 % CI 0.17-0.19). Compared with group P, groups R1 and R2 had significantly lower incidences of hypotension (both <i>P</i> < 0.05). In post-procedure stage, the patients in groups R1 and R2 took a longer time to recover and had a longer length of stay in the post anesthesia care unit than the patients in group P (all <i>P</i> < 0.05), although there was no statistically significant difference between groups R1 and R2. In addition, hypoxemia was more frequently observed in group P than in groups R1 and R2, although not reaching a statistically significant difference. All the other secondary outcome measurements and adverse events showed no statistically significant differences among the three groups.</p><p><strong>Conclusions: </strong>In elderly patients undergoing colonoscopic polypectomy, intravenous remimazolam bolus injection followed by continuous infusion could be applied with alfentanil to provide adequate sedation, with little disruption to hemodynamics. A continuous infusion of remimazolam at a dose of 0.5 mg/kg/h may be adopted due to its low impact on the post-procedure awakening time.</p>","PeriodicalId":519929,"journal":{"name":"Journal of anesthesia and translational medicine","volume":"4 2","pages":"65-72"},"PeriodicalIF":0.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13001786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147611230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}