临床与病理杂志2025，Vol.45Issue(7)：833-840,8.DOI:10.11817/j.issn.2095-6959.2025.240905
瑞马唑仑复合阿芬太尼在肥胖患者无痛胃镜检查中的95%有效剂量
Effective dose of remimazolam combined with alfentanil for painless gastroscopy in obese patients:determination of ED95
王曼 1黄瑾 1韩亚楠 1张亚平 2王旭 1许碗亮 1陈澄澄 3王春光1
作者信息
- 1. 保定市第一中心医院麻醉科,保定 071000
- 2. 保定市第一中心医院介入治疗室,保定 071000
- 3. 安新县中医医院麻醉科,保定 071600
- 折叠
摘要
Abstract
Objective:Remimazolam combined with alfentanil provides reliable anesthesia for painless gastroscopy;however,obesity significantly affects the pharmacokinetics of most anesthetic agents.Standard weight-based dosing may increase adverse events in obese patients,yet pharmacodynamic data on remimazolam in this population remain limited.This study aims to determine the effective dose for 95%of patients(ED95)of remimazolam combined with alfentanil for painless gastroscopy in obese patients using the biased coin design(BCD).
Methods:Eighty adult patients(aged 18 to 65 years;ASA class I to II)scheduled for elective painless gastroscopy under remimazolam-alfentanil anesthesia were enrolled.Based on body mass index(BMI),patients were divided into a control group and an obesity group.The BCD method was applied to calculate the ED95 of remimazolam.Before anesthesia induction,patients received preoxygenation at a flow rate of 4 L/min,followed by slow intravenous injection of alfentanil(5 µg/kg)and remimazolam.Gastroscopy commenced once eyelash reflex disappeared,the jaw relaxed,and the Modified Observer's Assessment of Alertness/Sedation Scale(MOAA/S)≤1.The initial dose of remimazolam was 0.10 mg/kg,with an increment of 0.02 mg/kg.If the MOAA/S remained>1 at 3 min or the patient exhibited movement,coughing,or swallowing that interfered with endoscopy,the response was recorded as positive(ineffective).Otherwise,it was negative(effective).After a positive response,the dose for the next patient was increased by 1 increment;after a negative response,the same dose was administered to the next patient with a 0.95 probability,or reduced by one increment with a 0.05 probability,until 40 cases were completed per group.
Results:Significant differences were found between the 2 groups in weight,height,and BMI(all P<0.05).The ED95[95%confidence interval(CI)]of remimazolam combined with alfentanil for painless gastroscopy was 0.157(0.142 to 0.168)mg/kg in the control group and 0.137(0.129 to 0.144)mg/kg in the obese group.The 83%CI did not overlap(P<0.05).In the control group,1 case of hypotension and 2 cases of hiccup occurred;in the obesity group,1 case each of hypotension,respiratory depression(pulse oxygen saturation<90%),and hiccup were observed.No other adverse events were reported.
Conclusion:The ED95 of remimazolam combined with alfentanil for painless gastroscopy is 0.157 mg/kg in normal-weight patients and 0.137 mg/kg in obese patients,indicating that obese individuals require a lower dose.Moreover,remimazolam does not increase the risk of respiratory depression in obese patients.关键词
肥胖/瑞马唑仑/阿芬太尼/胃镜检查/抛偏倚硬币设计Key words
obesity/remimazolam/alfentanil/gastroscopy/biased coin design引用本文复制引用
王曼,黄瑾,韩亚楠,张亚平,王旭,许碗亮,陈澄澄,王春光..瑞马唑仑复合阿芬太尼在肥胖患者无痛胃镜检查中的95%有效剂量[J].临床与病理杂志,2025,45(7):833-840,8.
