Discussion
tachycardia, anxiety, hypoxia, apnea, hypotension
HYPOXIA
In this study, we compared the efficacy, safety, and satisfaction profiles of remimazolam and midazolam as sedatives for flexible bronchoscopy. Remimazolam showed a shorter time from the end of the procedure to full alertness and time taken to reach peak sedation than midazolam. Not only were the drug-related side effects acceptable and easily manageable, but patient satisfaction was also significantly higher in the remimazolam group than in the midazolam group, especially for non-biopsy procedures. In addition, although not statistically significant, the remimazolam group tended to require lower antidote (i.e., flumazenil) usage.The major findings of our study were the rapid sedation and wakefulness induced by remimazolam. These results are consistent with those of a recently published clinical trial by Pastis et al., in which three groups (remimazolam or placebo in a double-blind manner and open-label midazolam) were compared during flexible bronchoscopyAnother notable finding of our study was that remimazolam was associated with higher patient satisfaction than midazolam in a subgroup of patients who underwent non-biopsy procedures. More than 80% of patients in the remimazolam group responded that they were willing to undergo repeat procedures. Several factors affect patient satisfaction after flexible bronchoscopy. Lower levels of anxiety before the procedure, shorter examination time, higher physician quality, and lower levels of discomfort during the procedure are associated with higher patient satisfactionTo date, many known drugs are used in bronchoscopy procedures. Benzodiazepines, alone or in combination with opioids, are the preferred sedative drugs for flexible bronchoscopyRemimazolam is similar to midazolam in terms of safety. In addition, remimazolam requires less antidote use after completion because it has the advantage of rapid recovery of neurological function. Benzodiazepines can act on the cardiovascular system causing hypotension and tachycardia and can also cause apnea and hypoxia by suppressing the respiratory centerThis study has several important clinical implications. Our findings suggest that remimazolam can achieve effective sedation and can be safely administered during bronchoscopy. This effect is also significant because the study directly compared midazolam and remimazolam, while excluding other analgesics (such as fentanyl or remifentanil), whereas, to date, midazolam has been used in combination with fentanyl.Despite these strengths, this study has several limitations. First, it was confined to a single center, and the sample size was relatively small. However, because the sample size that satisfied the primary endpoint was calculated based on previous studies