Combined Use of Remimazolam and Ciprofol Reduces Hypoxemia and Shortens Recovery Time During Sedated Gastrointestinal Endoscopy

Hai-Ding Zou,1,2 Cong Luo,1,2 Zhao-Lan Hu,1,2 Pei Zhou,1,2 Ru-Yi Luo1,2 1Department of Anesthesiology, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China; 2Anesthesia Medical Research Center, Central South University, Changsha, People’s Republic of ChinaCorrespondence: Ru-Yi Luo, Department of Anesthesiology, The Second Xiangya Hospital, Central South University, Central Ren-Min Road No. 139, Changsha, Hunan, 410011, People’s Republic of China, Email [email protected]: Hypoxemia is the most common adverse event during painless gastrointestinal endoscopy (PGIE). This study aimed to evaluate whether the combined use of remimazolam besylate and ciprofol (group RC) reduces the incidence of hypoxemia compared to ciprofol alone (group C) in patients undergoing PGIE under deep sedation.Methods: A total of 246 patients scheduled for PGIE were recruited from the Second Xiangya Hospital of Central South University and randomly assigned to group C or RC. The primary outcome measured was the incidence of intraoperative hypoxemia. Secondary outcomes included physiological parameters such as blood pressure, heart rate, and oxygen saturation (SpO2) during the procedure, along with time to loss of consciousness (LoC), time to awakening, and major adverse effects (MAEs). Additionally, correlations between minimum SpO2 and factors like body mass index (BMI), age, and preoperative SpO2 were examined.Results: Group C exhibited a significantly higher incidence and frequency of hypoxemia compared to group RC. Correlation analysis revealed that minimum SpO2 was inversely related to age and BMI, while showing a positive correlation with preoperative SpO2. Additionally, the RC group demonstrated significantly decreased induction and shorter times to LoC and awakening than group C.Conclusion: The combined administration of ciprofol and remimazolam besylate may enhance the safety profile of deep sedation for PGIE compared to ciprofol alone, offering reduced hypoxemia incidence and improved procedural efficiency.Trial Registration: www.chictr.org.cn (Registration number: ChiCTR2400092506, Registration date: November 18, 2024).Keywords: hypoxemia, remimazolam besylate, ciprofol, oxygen saturation, sedation