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已发表论文
不同剂量托烷司琼盐酸瑞马唑仑联合艾司氯胺酮在无痛人工流产患者中的疗效：一项前瞻性、双盲、随机对照试验
Authors Chen J, Zhang J, Zhang M, Zou X , Hu B , Yang Y , Li H
Received 21 June 2025
Accepted for publication 23 September 2025
Published 8 October 2025 Volume 2025:19 Pages 9117—9126
DOI https://doi.org/10.2147/DDDT.S548701
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Anastasios Lymperopoulos
Jiejuan Chen,1,* Jingchao Zhang,2,* Mazhong Zhang,1– 3 Xiaohua Zou,4 Bailong Hu,4 Yang Yang,4 Hui Li4
1Department of Anesthesiology, Guizhou Medical University, Guiyang City, Guizhou Province, People’s Republic of China; 2Department of Anesthesiology, Guizhou Provincial People’s Hospital, Guiyang City, Guizhou Province, People’s Republic of China; 3Department of Anesthesiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China; 4Department of Anesthesiology, Affiliated Hospital of Guizhou Medical University, Guiyang City, Guizhou Province, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Mazhong Zhang, Email zmzscmc@shsmu.edu.cn Xiaohua Zou, Email zouxiaohuazxh@163.com
Background: Remimazolam tosilate (RT) is a novel ultra-short-acting benzodiazepine with rapid onset, short half-life, stable hemodynamics, and minimal respiratory depression. This study aimed to assess the efficacy, safety, and optimal dosage of RT combined with esketamine for painless abortion procedures.
Methods: This single-center, prospective, randomized, double-blind trial was conducted from December 2022 to December 2024. A total of 210 patients (aged 18– 45 years, ASA I–II, BMI 18– 28 kg/m2) undergoing elective painless abortion were randomly assigned to one of three groups: propofol 2 mg/kg (Group P), RT 0.2 mg/kg (Group RL), or RT 0.3 mg/kg (Group RH). Primary outcomes were perioperative hemodynamic changes, assessed by mean arterial pressure fluctuation value (ΔMAP) and heart rate fluctuation value (ΔHR). Secondary outcomes included adverse events, vital sign changes, induction and recovery times, surgical duration, time to discharge readiness, need for additional sedation, visual analogue scale (VAS) pain scores at awakening and discharge, and satisfaction levels of patients, surgeons, and anesthesiologists.
Results: The ΔMAP in Group RL (7.11 ± 2.49) was significantly lower than in Group P (11.93 ± 2.09) and Group RH (12.80 ± 2.59) (F = 114.286, P < 0.001), indicating more stable perioperative hemodynamics. Group RL also showed shorter recovery time and quicker discharge readiness. Hypotension incidence was lower in Groups P and RL compared to RH. Rates of hypoxemia, nausea/vomiting, and neuropsychiatric symptoms were significantly lower in Groups RL and RH than in Group P. RT required fewer supplemental doses than propofol, and patient satisfaction was highest in Group RL. No significant differences were observed among groups for ΔHR, induction time, surgical duration, hypertension, body movement, injection pain, postoperative pain, or patient/surgeon/anesthesiologist satisfaction.
Conclusion: Low-dose RT (0.2 mg/kg) combined with esketamine significantly shortens recovery and discharge times, ensures hemodynamic stability, and reduces adverse events, making it the recommended sedation strategy for painless abortion procedures.
Keywords: remimazolam tosilate, esketamine, propofol, painless abortion, hemodynamics
1Department of Anesthesiology, Guizhou Medical University, Guiyang City, Guizhou Province, People’s Republic of China; 2Department of Anesthesiology, Guizhou Provincial People’s Hospital, Guiyang City, Guizhou Province, People’s Republic of China; 3Department of Anesthesiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China; 4Department of Anesthesiology, Affiliated Hospital of Guizhou Medical University, Guiyang City, Guizhou Province, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Mazhong Zhang, Email zmzscmc@shsmu.edu.cn Xiaohua Zou, Email zouxiaohuazxh@163.com
Background: Remimazolam tosilate (RT) is a novel ultra-short-acting benzodiazepine with rapid onset, short half-life, stable hemodynamics, and minimal respiratory depression. This study aimed to assess the efficacy, safety, and optimal dosage of RT combined with esketamine for painless abortion procedures.
Methods: This single-center, prospective, randomized, double-blind trial was conducted from December 2022 to December 2024. A total of 210 patients (aged 18– 45 years, ASA I–II, BMI 18– 28 kg/m2) undergoing elective painless abortion were randomly assigned to one of three groups: propofol 2 mg/kg (Group P), RT 0.2 mg/kg (Group RL), or RT 0.3 mg/kg (Group RH). Primary outcomes were perioperative hemodynamic changes, assessed by mean arterial pressure fluctuation value (ΔMAP) and heart rate fluctuation value (ΔHR). Secondary outcomes included adverse events, vital sign changes, induction and recovery times, surgical duration, time to discharge readiness, need for additional sedation, visual analogue scale (VAS) pain scores at awakening and discharge, and satisfaction levels of patients, surgeons, and anesthesiologists.
Results: The ΔMAP in Group RL (7.11 ± 2.49) was significantly lower than in Group P (11.93 ± 2.09) and Group RH (12.80 ± 2.59) (F = 114.286, P < 0.001), indicating more stable perioperative hemodynamics. Group RL also showed shorter recovery time and quicker discharge readiness. Hypotension incidence was lower in Groups P and RL compared to RH. Rates of hypoxemia, nausea/vomiting, and neuropsychiatric symptoms were significantly lower in Groups RL and RH than in Group P. RT required fewer supplemental doses than propofol, and patient satisfaction was highest in Group RL. No significant differences were observed among groups for ΔHR, induction time, surgical duration, hypertension, body movement, injection pain, postoperative pain, or patient/surgeon/anesthesiologist satisfaction.
Conclusion: Low-dose RT (0.2 mg/kg) combined with esketamine significantly shortens recovery and discharge times, ensures hemodynamic stability, and reduces adverse events, making it the recommended sedation strategy for painless abortion procedures.
Keywords: remimazolam tosilate, esketamine, propofol, painless abortion, hemodynamics