Procedural sedation with remimazolam in upper GI endoscopy during emergencies

Remimazolam is a new intravenous anesthetic from the group of benzodiazepines.It is specific because of its ultra-short action and quick recovery after application. With a mechanism of action similar to classic benzodiazepines, remimazolam appears to be an ideal sedative for procedural sedation during short procedures. Due to its pharmacological profile, rapid onset of action and short duration of sedation after stopping the drug and the availability of antagonists, there is great potential for its use during short diagnostic or therapeutic procedures.

Remimazolam was used when performing gastroscopy in emergency interventional conditions, i.e. when stopping bleeding by clipping, sclerosing and placing ligatures on varicosities of the esophagus. The doctor specializing in gastroenterology who performed the procedure determined the dose of medicine, which was then administered to the patient by a well-educated nurse. A well-educated nurse is authorized to use this medicine, of course, under the supervision of a doctor. It is important that the nurse, with her knowledge and experience, can accompany the patient during the procedure and drug administration in order to prevent unwanted side effects and react in a timely manner if they occur [1].

Before the actual administration the procedure of performing the gastroscopy should be explained to the patient and he should be placed in the appropriate position on his left side. The nurse secures the correct venous route for drug administration and connects the patient to a monitor for continuous monitoring of vital functions during the procedure. The nurse records the vital functions of the patient before the administration of the medicine, then during the administration of the medicine and the gastroscopy procedure itself, and after the administration of the medicine until the patient fully wakes up. The use of these drug helped us to keep the patient calm during the gastroscopy, and the nurse can devote herself to the process of stopping the bleeding, depending on which intervention is being performed. A well-educated nurse plays an important role in these conditions. With constant education and upgrading of knowledge, the nurse can help the doctor when performing the procedure, and with her knowledge she can help the patient if unwanted side effects occur.

Patients who require an urgent gastroscopy with a certain intervention and before the procedure itself are disturbed and frightened because of the condition they are in, and the examination as such can further disturb them, therefore the use of remimazolam greatly helped during the procedure itself. During the examination, the patients are calm and easily tolerate the procedure, which greatly helps the nurse and doctor who perform the procedure and a specific intervention, and the examination takes less time. It is important to note that patients wake up very quickly after stopping the drug and are not agitated.

 

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Conflicts of Interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Hu Q, Liu X, Wen C, Li D, Lei X.. Remimazolam: An Updated Review of a New Sedative and Anaesthetic. Drug Des Devel Ther 2022; 16: 3957-3974

Publication History

Article published online:
27 March 2025