Safety and Efficacy of Remimazolam Compared With Placebo and Midazolam for Moderate Sedation During Bronchoscopy
| Autor: | Randall Ostroff, Gerard A. Silvestri, Momen M. Wahidi, Lonny Yarmus, Michael A. Pritchett, I. M. Ndukwu, Nichole T. Tanner, Paion Investigators, Sean P. Callahan, Jason Akulian, Frank Schippers, Gregory Feldman, Alexander Chen, Daniel G. Lorch, Nicholas J. Pastis, Samira Shojaee |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine Midazolam Sedation Conscious Sedation Critical Care and Intensive Care Medicine Placebo Benzodiazepines Young Adult Double-Blind Method Bronchoscopy Humans Hypnotics and Sedatives Medicine Prospective Studies Infusions Intravenous Flexible bronchoscopy Aged Moderate sedation Aged 80 and over Dose-Response Relationship Drug medicine.diagnostic_test business.industry Middle Aged Anesthesia Female Onset of action medicine.symptom Cardiology and Cardiovascular Medicine business Remimazolam medicine.drug |
| Zdroj: | Chest. 155:137-146 |
| ISSN: | 0012-3692 |
| DOI: | 10.1016/j.chest.2018.09.015 |
| Popis: | While the complexity of flexible bronchoscopy has increased, standard options for moderate sedation medications have not changed in three decades. There is a need to improve moderate sedation while maintaining safety. Remimazolam was developed to address shortcomings of current sedation strategies.A prospective, double-blind, randomized, multicenter, parallel group trial was performed at 30 US sites. The efficacy and safety of remimazolam for sedation during flexible bronchoscopy were compared with placebo and open-label midazolam.The success rates were 80.6% in the remimazolam arm, 4.8% in the placebo arm (P .0001), and 32.9% in the midazolam arm. Bronchoscopy was started sooner in the remimazolam arm (mean, 6.4 ± 5.82 min) compared with placebo (17.2 ± 4.15 min; P .0001) and midazolam (16.3 ± 8.60 min). Time to full alertness after the end of bronchoscopy was significantly shorter in patients treated with remimazolam (median, 6.0 min; 95% CI, 5.2-7.1) compared with those treated with placebo (13.6 min; 95% CI, 8.1-24.0; P = .0001) and midazolam (12.0 min; 95% CI, 5.0-15.0). Remimazolam registered superior restoration of neuropsychiatric function compared with placebo and midazolam. Safety was comparable among all three arms, and 5.6% of the patients in the remimazolam group had serious treatment-emergent adverse events as compared with 6.8% in the placebo group.Remimazolam administered under the supervision of a pulmonologist was effective and safe for moderate sedation during flexible bronchoscopy. In an exploratory analysis, it demonstrated a shorter onset of action and faster neuropsychiatric recovery than midazolam. |
| Databáze: | OpenAIRE |
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