Discussion
hepatic or renal impairment
ADVERSE EVENTS, CRITICALLY ILL
We conducted a pilot study to compare remimazolam besylate with propofol for deep sedation in critically ill patients. We found that the percentage of time within the target sedation range without rescue sedation was similar between the two groups, as well as clinical outcomes and adverse events.Remimazolam besylate undergoes organ-independent metabolism and is hydrolyzed by tissue esterases into an inactive metabolite. Long-term infusion and high doses are unlikely to cause accumulation or extended effects [The median infusion rate of remimazolam besylate was 0.60 mg/kg/h in our study, which was higher than infusion rate in our previous study on patients with light to moderate sedation, in whom was 0.18 mg/kg/h [Strengths of the present study are that this is the first study comparing remimazolam besylate with propofol in deep sedation, and the level of sedation was assessed using both RASS and the Narcotrend Index. There are several limitations. First, the sample size is small. Second, nurses and physicians were not blinded, as the physical appearance of the two sedatives was obviously different. However, nurses were randomly involved in the care of all the patients during the ICU stay. Third, the duration of study drug infusion was relatively short, and the benefits or risks of using remimazolam besylate for deep sedation beyond 48 h were remain unknown. Fourth, we excluded patients with severe hepatic or renal impairment as recommended by our ethics committee, because the package insert states that limited data are available for these patients.