Patient-controlled sedation with remimazolam in outpatient colonoscopy: a feasibility pilot study

OBJECTIVE: To evaluate the feasibility, safety, and patient satisfaction of patient-controlled sedation (PCS) with remimazolam during outpatient colonoscopy. MATERIAL AND METHODS: This quality improvement project was approved by the Institutional Review Board. Ten patients (median age 60.5 years, range 53-71; 50% female) underwent colonoscopy using PCS via an infusion pump (CADD-Solis). The protocol included an initial bolus of 5-7.5 mg remimazolam plus 1 mg alfentanil, followed by patient-controlled 2.5 mg boluses with a 2-minute lockout. Vital signs were continuously monitored, and adverse events were classified according to the international reporting tool on adverse events in sedation. RESULTS: All procedures were completed successfully. The median total remimazolam dose was 14 mg (range 5-27.5), and median procedure time was 41 minutes (range 23-105). No serious adverse events occurred; one patient (10%) experienced brief, transient oxygen desaturation that resolved spontaneously. Hemodynamic stability was maintained throughout. Patient satisfaction was high across all domains, with median scores ranging from 4.5 to 5.0. CONCLUSION: Remimazolam PCS appears feasible, safe, and well tolerated for colonoscopy, with high patient satisfaction. Larger studies are warranted to confirm these findings and optimize dosing strategies. .