Effects of remimazolam tosilate on gastrointestinal hormones and gastrointestinal motility in patients undergoing gastrointestinal endoscopy with sedation: a randomized control trial

Purpose To investigate the impacts of remimazolam tosilate on gastrointestinal hormones and motility in patients undergoing gastrointestinal endoscopy with sedation. Methods A total of 262 American Society of Anesthesiologists Physical Status I or II patients, aged 18-65 years, scheduled for gastrointestinal endoscopy with sedation, were randomly allocated into two groups (n = 131 each): the remimazolam tosilate group (Group R) and the propofol group (Group P). Patients in Group R received 0.2-0.25 mg/Kg remimazolam tosilate intravenously, while those in Group P received 1.5-2.0 mg/kg propofol intravenously. The gastrointestinal endoscopy was performed when the Modified Observer's Assessment of Alertness/Sedation scores were <= 3. The primary endpoints included the endoscopic intestinal peristalsis rating by the endoscopist; serum motilin and gastrin levels at fasting without gastrointestinal preparation (T0), before gastrointestinal endoscopy (T-1), and before leaving the Post Anesthesia Care Unit (T-2); and the incidences of abdominal distension during Post Anesthesia Care Unit. Results Compared with Group P, intestinal peristalsis rating was higher in Group R (P < .001); Group R showed increased motilin and gastrin levels at T-2 compared with Group P (P < .01). There was a rise in motilin and gastrin levels at T1 and T-2 compared with T0 and at T-2 compared with T1 in both groups (P < .01). The incidence of abdominal distension was lower in Group R (P < .05). Conclusion Compared with propofol used during gastrointestinal endoscopy with sedation, remimazolam tosilate mildly inhibits the serum motilin and gastrin levels, potentially facilitating the recovery of gastrointestinal motility. What is already known on this topic Remimazolam tosilate (RT), as a novel ultrashort-acting benzodiazepine, has been recently used in gastrointestinal endoscopy with sedation. Nevertheless, the effects of RT on gastrointestinal hormones and gastrointestinal motility remain unclear. What this study adds Compared with propofol used in gastrointestinal endoscopy with sedation, RT mildly inhibits serum motilin and gastrin levels and gastrointestinal motility. How this study might affect research, practice, or policy RT sedation for gastrointestinal endoscopy might contribute to recovery of gastrointestinal function.