Annals of Medicine (Dec 2025)

Remifentanil enhances the sedative effect of remimazolam during anesthesia induction in patients undergoing hysteroscopy: a randomized controlled trial

  • Zhengui Xie,
  • Yeqing Liao,
  • Qiuling Chen,
  • Cuiwen Zhang,
  • Jiaxin Luo,
  • Huiyu Cao,
  • Yuliu Lin,
  • Hongmeng Lan,
  • Xiaofang Huang,
  • Xuehai Guan

DOI
https://doi.org/10.1080/07853890.2025.2534850
Journal volume & issue
Vol. 57, no. 1

Abstract

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Background Remimazolam is a novel, short-acting benzodiazepine. This study aimed to investigate whether remifentanil enhances the sedative effect of remimazolam during anesthesia induction in patients undergoing hysteroscopy.Methods We included 258 adult patients who underwent hysteroscopy. Patients were randomly allocated to three groups (n = 86) in a 1:1:1 ratio. Patients in the saline group received no remifentanil but normal saline during anesthesia induction. Patients in the remifentanil-1 group received low-dose remifentanil (plasma concentration 1 ng/ml), and those in the remifentanil-2 group received higher doses of remifentanil (plasma concentration 2 ng/ml) during anesthesia induction. After reaching the preset plasma concentration of remifentanil, remimazolam was administered (5 mg/kg/h) until loss of consciousness (LOC). During anesthesia maintenance, remimazolam and remifentanil were changed to ensure that the MOAA/S score reached 0. The primary outcome was the time from remimazolam administration to LOC. The secondary outcomes included the doses of remimazolam until LOC, characteristics of the operation and anesthesia, vital signs, and adverse events.Results The time from remimazolam administration to LOC was 154 (139, 180), 120 (104, 139), and 117 (105, 135) s in the saline group, remifentanil-1group, and remifentanil-2 groups, respectively (p < 0.05). The doses of remimazolam until LOC were 12(11, 13), 9.6(8.7, 11), and 8.9(7.9, 10) mg in the saline group, remifentanil-1group, and remifentanil-2 groups, respectively (p < 0.05). There was no significant difference in the characteristic of surgery and anesthesia between groups.Conclusion Remifentanil enhances the sedative effect of remimazolam during anesthesia induction in patients undergoing hysteroscopy.Clinical trial registration The trial was registered at http://www.chictr.org.cn (ChiCTR2200062983).

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