Interactions Between Remimazolam and Propofol in Combination With Sufentanil for Anesthesia During Gastroscopy
Abstract Background This study was conducted to determine how remimazolam and propofol interact when given with sufentanil. Methods In this single-arm study, patients were assigned to one of five groups. The sample size was not determined in advance. When the median effective dose(ED50) and 95% confidence intervals were calculated, participants were stopped. The study included 159 patients who were scheduled for a gastrointestinal endoscopic examination and had an American Society of Anesthesiologists physical status of I/II. Patients were intravenously administered sufentanil (0.1 µg/kg), along with different doses of remimazolam and propofol depending on the group to which they were assigned. The endpoint for an effective response was the disappearance of the bilateral eyelash reflex. The up-and-down method was used to determine the ED50 within each treatment group. The ED50 deviations from the additive line were analyzed using isoradiometric analysis. The interaction coefficients were calculated by algebraic analysis. Interval estimation is used in statistical inference. Results In combination with sufentanil, the ED50 of remimazolam and propofol was determined to be 0.065 (0.057-0.074) mg/kg and 0.657 (0.590-0.724) mg/kg, respectively. After sufentanil administered, when 0.25, 0.5, and 0.75 ED50 remimazolam were given in combination with propofol, the interaction coefficients were 1.03,1.2and 1.08, respectively. Conclusions The dose of propofol with remimazolam may need to be reduced regardless of the additive or synergistic effect. There was a strong synergistic effect when the dose ratio of the two drugs was about 6:1 in mg/kg. Trial registration: The project was retrospectively registered on October 26, 2021 in Chinese clinical trial center with the registration number of ChiCTR2100052425.