To evaluate the dose-response relationship of remimazolam for sedation in cirrhosis patients undergoing endoscopy for esophagogastric varices.

A total of 40 cirrhotic patients, aged 18-65 years, with American Society of Anesthesiologists grades Ⅱ and Ⅲ, body mass index (BMI) 18.5-27.9 kg/m² and Child-Pugh grade A, who underwent endoscopy for esophagogastric varices in Affiliated Hospital of Qinghai University from June 2021 to August 2022 were included. The patients were first intravenously injected with sufentanil at 0.15 μg/kg followed by remimazolam 2 min later. The initial dose of remimazolam was set at 0.15 mg/kg (with a dose gradient of 0.025 mg/kg), and the modified Dixon sequential method was used to determine the dose of remimazolam in the next patient. The number of patients with successful sedation and failed sedation was recorded, and the patients were divided into two groups: a successful sedation group (n=21) and a failed sedation group (n=19). The levels of albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil), recovery time, length of post-anesthesia care unit (PACU) stay, intraoperative respiratory depression, hypotension, bradycardia, as well as the incidences of postoperative dizziness, nausea and vomiting, delayed recovery and agitation were recorded in the two groups. The median effective dose (ED₅₀) and 95% effective dose (ED₉₅) of remimazolam during endoscopy for esophagogastric varices in cirrhosis patients were calculated by Probit regression analysis.

The ED₅₀ and 95% confidence interval (CI) of remimazolam during endoscopy for esophagogastric varices in cirrhosis patients were 0.105 (0.095-0.115) mg/kg, and the ED₉₅ and 95%CI were 0.141 (0.116-0.166) mg/kg. There was no statistical difference in the levels of albumin, ALT, AST and TBil, recovery time, length of PACU stay, as well as the incidences of intraoperative respiratory depression, hypotension, bradycardia, postoperative dizziness, nausea and vomiting, delayed recovery and agitation between the two groups (all P>0.05).

The ED₅₀ and ED₉₅ values of remimazolam during endoscopy for esophagogastric varices in cirrhosis patients were 0.105 mg/kg and 0.141 mg/kg, respectively.

Remimazolam; Esophageal varices; Endoscopy; Cirrhosis; Dose-effect relationship