{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T10:18:09Z","timestamp":1784715489534,"version":"3.55.0"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T00:00:00Z","timestamp":1691020800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\n Introduction<\/jats:title>\n Hypotension is the most common adverse event under propofol-mediated sedation and is possible to cause varying degrees of damage to patients. Whereas remimazolam has a poorer sedative effect than propofol.<\/jats:p>\n <\/jats:sec>\n \n Aim<\/jats:title>\n The aim of this study was to explore the advantages of the combination of remimazolam tosylate and propofol.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 304 patients were divided into the remimazolam tosylate group (RT group), the propofol group (P group), and the remimazolam tosylate plus propofol group(R+T group). The primary outcome was the incidence of hypotension. Secondary outcomes included the results of sedation and recovery. The safety results mainly include the incidence of Hypotension, adverse respiratory events, postoperative nausea and vomiting, hiccup, cough, body movement and bradycardia.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The incidence of hypotension was 56.7% in the P group, 12.6% in the RT group, and 31.3% in the R+P group, three groups of pairwise comparisons showed statistical differences, with\n P<\/jats:italic>\n < 0.001. The incidence of body movement was significantly higher in the RT group (26.1%) than in the P group (10.3%) and the R+P group (12.5%),\n P<\/jats:italic>\n = 0.004. The endoscopist satisfaction was higher in the P (3.87\u00b10.44) and R+P (3.95\u00b10.22)groups than in the RT(3.53\u00b10.84) group. The incidence of adverse events, in descending order, was P group, RT group, and R+P group (93.8%vs.61.3%vs.42.7%).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Co-administration had fewer adverse events than propofol monotherapy, also had a better sedative effect and higher endoscopist satisfaction than remimazolam monotherapy.<\/jats:p>\n <\/jats:sec>\n \n Trial registration<\/jats:title>\n \n Clinical trial registration number:<\/jats:bold>\n NCT05429086<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0282930","type":"journal-article","created":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T13:41:41Z","timestamp":1691070101000},"page":"e0282930","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":29,"title":["The safety and efficacy of remimazolam tosylate combined with propofol in upper gastrointestinal endoscopy: A multicenter, randomized clinical trial"],"prefix":"10.1371","volume":"18","author":[{"given":"Ai","family":"Wei","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shijin","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuzhe","family":"Dou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianxiong","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuzhi","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanfang","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinquan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongming","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6813-4174","authenticated-orcid":true,"given":"Mengchang","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,8,3]]},"reference":[{"issue":"10251","key":"pone.0282930.ref001","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1016\/S0140-6736(20)31288-5","article-title":"Gastric cancer.","volume":"396","author":"EC Smyth","year":"2020","journal-title":"Lancet"},{"key":"pone.0282930.ref002","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/978-3-319-41388-4_14","article-title":"Endoluminal Diagnosis of Early Gastric Cancer and Its Precursors: Bridging the Gap Between Endoscopy and Pathology","volume":"908","author":"N Uedo","year":"2016","journal-title":"Advances in experimental medicine and biology"},{"issue":"2","key":"pone.0282930.ref003","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.gie.2017.07.018","article-title":"Guidelines for sedation and anesthesia in GI endoscopy.","volume":"87","author":"DS Early","year":"2018","journal-title":"Gastrointest Endosc."},{"issue":"3","key":"pone.0282930.ref004","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/j.gie.2021.11.039","article-title":"Impact of colonoscopy on working productivity: a prospective multicenter observational study.","volume":"95","author":"L Fuccio","year":"2022","journal-title":"Gastrointest Endosc."},{"issue":"1","key":"pone.0282930.ref005","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.gie.2020.05.045","article-title":"Propofol compared with bolus and titrated midazolam for sedation in outpatient colonoscopy: a prospective randomized double-blind study.","volume":"93","author":"DB Kim","year":"2021","journal-title":"Gastrointest Endosc"},{"issue":"3","key":"pone.0282930.ref006","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1097\/SLE.0000000000000532","article-title":"The Comparison of Midazolam and Propofol in Gastrointestinal Endoscopy: A Systematic Review and Meta-analysis.","volume":"28","author":"R Zhang","year":"2018","journal-title":"Surg Laparosc Endosc Percutan Tech."},{"issue":"4","key":"pone.0282930.ref007","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1016\/j.bja.2021.10.044","article-title":"Hypotension during propofol sedation for colonoscopy: a retrospective exploratory analysis and meta-analysis","volume":"128","author":"JR Sneyd","year":"2022","journal-title":"Br J Anaesth"},{"issue":"1","key":"pone.0282930.ref008","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1093\/bja\/aew393","article-title":"Safety of sedation for gastrointestinal endoscopy in a group of university-affiliated hospitals: a prospective cohort study","volume":"118","author":"K Leslie","year":"2017","journal-title":"Br J Anaesth"},{"key":"pone.0282930.ref009","doi-asserted-by":"crossref","first-page":"938940","DOI":"10.3389\/fmed.2022.938940","article-title":"The hemodynamic stability of remimazolam compared with propofol in patients undergoing endoscopic submucosal dissection: A randomized trial.","volume":"9","author":"Y Qiu","year":"2022","journal-title":"Front Med (Lausanne)."},{"issue":"6","key":"pone.0282930.ref010","first-page":"1654","article-title":"Intraoperative hypotension is associated with adverse clinical outcomes after noncardiac surgery.","volume":"132","author":"A Gregory","year":"2021"},{"issue":"2","key":"pone.0282930.ref011","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1097\/ALN.0000000000003048","article-title":"Associations of Intraoperative Radial Arterial Systolic, Diastolic, Mean, and Pulse Pressures with Myocardial and Acute Kidney Injury after Noncardiac Surgery: A Retrospective Cohort Analysis","volume":"132","author":"S Ahuja","year":"2020","journal-title":"Anesthesiology"},{"issue":"3","key":"pone.0282930.ref012","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/j.gie.2018.04.2351","article-title":"A phase III study evaluating the efficacy and safety of remimazolam (CNS 7056) compared with placebo and midazolam in patients undergoing colonoscopy.","volume":"88","author":"DK Rex","year":"2018","journal-title":"Gastrointest Endosc"},{"issue":"4","key":"pone.0282930.ref013","doi-asserted-by":"crossref","first-page":"307","DOI":"10.4097\/kja.22297","article-title":"Remimazolam\u2014current knowledge on a new intravenous benzodiazepine anesthetic agent.","volume":"75","author":"SH Kim","year":"2022","journal-title":"Korean J Anesthesiol"},{"issue":"3","key":"pone.0282930.ref014","first-page":"e22881","article-title":"Efficacy of Remimazolam for Procedural Sedation in American Society of Anesthesiologists (ASA) I to IV Patients Undergoing Colonoscopy: A Systematic Review and Meta-Analysis.","volume":"14","author":"I Ul-Haque","year":"2022","journal-title":"Cureus."},{"issue":"5","key":"pone.0282930.ref015","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1213\/ANE.0b013e3182a705ae","article-title":"A phase Ib, dose-finding study of multiple doses of remimazolam (CNS 7056) in volunteers undergoing colonoscopy.","volume":"117","author":"MT Worthington","year":"2013","journal-title":"Anesth Analg"},{"key":"pone.0282930.ref016","article-title":"Effect of remimazolam versus propofol sedation on the quality of recovery after colonoscopy: A randomised, controlled, noninferiority trial.","author":"L Guo","year":"2022","journal-title":"Eur J Anaesthesiol."},{"issue":"1","key":"pone.0282930.ref017","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1186\/s12871-022-01805-3","article-title":"Sedative effect of remimazolam combined with alfentanil in colonoscopic polypectomy: a prospective, randomized, controlled clinical trial.","volume":"22","author":"Y Xin","year":"2022","journal-title":"BMC Anesthesiol"},{"key":"pone.0282930.ref018","doi-asserted-by":"crossref","first-page":"655042","DOI":"10.3389\/fmed.2021.655042","article-title":"Efficacy and Safety of Remimazolam in Endoscopic Sedation-A Systematic Review and Meta-Analysis.","volume":"8","author":"X Zhu","year":"2021","journal-title":"Front Med (Lausanne)."},{"issue":"2","key":"pone.0282930.ref019","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.bja.2021.03.015","article-title":"Perioperative hypotension 2021: a contrarian view","volume":"127","author":"T Kappen","year":"2021","journal-title":"Br J Anaesth"},{"issue":"2","key":"pone.0282930.ref020","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1097\/01.anes.0000270724.40897.8e","article-title":"Incidence of intraoperative hypotension as a function of the chosen definition: literature definitions applied to a retrospective cohort using automated data collection","volume":"107","author":"JB Bijker","year":"2007","journal-title":"Anesthesiology"},{"issue":"7","key":"pone.0282930.ref021","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1001\/jamainternmed.2013.2908","article-title":"Complications following colonoscopy with anesthesia assistance: a population-based analysis.","volume":"173","author":"GS Cooper","year":"2013","journal-title":"JAMA internal medicine"},{"issue":"2","key":"pone.0282930.ref022","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1111\/jgh.15188","article-title":"Remimazolam tosilate in upper gastrointestinal endoscopy: A multicenter, randomized, non-inferiority, phase III trial","volume":"36","author":"SH Chen","year":"2021","journal-title":"J Gastroenterol Hepatol"},{"issue":"5","key":"pone.0282930.ref023","doi-asserted-by":"crossref","first-page":"L1007","DOI":"10.1152\/ajplung.00171.2007","article-title":"Differential effects of intravenous anesthetics on capacitative calcium entry in human pulmonary artery smooth muscle cells","volume":"294","author":"M Yang","year":"2008","journal-title":"American journal of physiology Lung cellular and molecular physiology"},{"issue":"1","key":"pone.0282930.ref024","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1097\/00000542-200507000-00007","article-title":"Sympathetic and hemodynamic effects of moderate and deep sedation with propofol in humans","volume":"103","author":"TJ Ebert","year":"2005","journal-title":"Anesthesiology"},{"issue":"16","key":"pone.0282930.ref025","first-page":"1388","article-title":"Propofol evokes endothelium-independent relaxation in rabbit thoracic aorta strips: role of K+ channels","volume":"118","author":"AL Luo","year":"2005","journal-title":"Chinese medical journal"},{"issue":"1","key":"pone.0282930.ref026","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1186\/s12871-022-01713-6","article-title":"Remimazolam tosilate compared with propofol for gastrointestinal endoscopy in elderly patients: a prospective, randomized and controlled study.","volume":"22","author":"J Guo","year":"2022","journal-title":"BMC Anesthesiol"},{"issue":"8","key":"pone.0282930.ref027","first-page":"4594","article-title":"The efficacy and safety of remimazolam tosylate versus propofol in patients undergoing colonoscopy: a multicentered, randomized, positive-controlled, phase III clinical trial","volume":"12","author":"S Chen","year":"2020","journal-title":"American journal of translational research"},{"key":"pone.0282930.ref028","doi-asserted-by":"crossref","first-page":"74","DOI":"10.4103\/abr.abr_186_17","article-title":"Comparison the Effect of Granisetron and Dexamethasone on Intravenous Propofol Pain.","volume":"7","author":"L Adinehmehr","year":"2018","journal-title":"Advanced biomedical research"},{"issue":"4","key":"pone.0282930.ref029","doi-asserted-by":"crossref","first-page":"562","DOI":"10.5009\/gnl20243","article-title":"Pain Intensity at Injection Site during Esophagogastroduodenoscopy Using Long- and Medium-Chain versus Long-Chain Triglyceride Propofol: A Randomized Controlled Double-Blind Study.","volume":"15","author":"JS Lee","year":"2021","journal-title":"Gut Liver"},{"key":"pone.0282930.ref030","doi-asserted-by":"crossref","first-page":"d1110","DOI":"10.1136\/bmj.d1110","article-title":"Prevention of pain on injection of propofol: systematic review and meta-analysis","volume":"342","author":"L Jalota","year":"2011","journal-title":"BMJ (Clinical research ed)."},{"issue":"11","key":"pone.0282930.ref031","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1111\/j.1365-2044.1985.tb10615.x","article-title":"Assessment and modification of pain on induction with propofol (Diprivan).","volume":"40","author":"MJ McCulloch","year":"1985","journal-title":"Anaesthesia."},{"issue":"2","key":"pone.0282930.ref032","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1213\/ANE.0b013e31823acb95","article-title":"Remimazolam: new beginnings or just a me-too?","volume":"115","author":"JR Sneyd","year":"2012","journal-title":"Anesth Analg"},{"issue":"1","key":"pone.0282930.ref033","doi-asserted-by":"crossref","first-page":"24514","DOI":"10.52965\/001c.24514","article-title":"A comprehensive review of remimazolam for sedation.","volume":"9","author":"N Noor","year":"2021","journal-title":"Health psychology research."},{"key":"pone.0282930.ref034","doi-asserted-by":"crossref","first-page":"4551","DOI":"10.2147\/DDDT.S334100","article-title":"Efficacy of Pre-Treatment with Remimazolam on Prevention of Propofol-Induced Injection Pain in Patients Undergoing Abortion or Curettage: A Prospective, Double-Blinded, Randomized and Placebo-Controlled Clinical Trial.","volume":"15","author":"X Guan","year":"2021","journal-title":"Drug Des Devel Ther."},{"key":"pone.0282930.ref035","doi-asserted-by":"crossref","DOI":"10.1097\/EJA.0000000000001715","article-title":"Discharge readiness after remimazolam versus propofol for colonoscopy: A randomised, double-blind trial.","author":"Y Yao","year":"2022","journal-title":"Eur J Anaesthesiol."},{"issue":"5","key":"pone.0282930.ref036","doi-asserted-by":"crossref","first-page":"565","DOI":"10.23736\/S0375-9393.19.13949-1","article-title":"Sedation in digestive endoscopy: innovations for an old technique.","volume":"86","author":"G De Cosmo","year":"2020","journal-title":"Minerva Anestesiol"},{"issue":"1","key":"pone.0282930.ref037","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1097\/ALN.0000000000002232","article-title":"Neuropsychological and Behavioral Outcomes after Exposure of Young Children to Procedures Requiring General Anesthesia: The Mayo Anesthesia Safety in Kids (MASK) Study.","volume":"129","author":"DO Warner","year":"2018","journal-title":"Anesthesiology"},{"issue":"7","key":"pone.0282930.ref038","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1111\/jcpt.13635","article-title":"ED(50) and ED(95) of propofol combined with different doses of esketamine for children undergoing upper gastrointestinal endoscopy: A prospective dose-finding study using up-and-down sequential allocation method.","volume":"47","author":"XS Zheng","year":"2022","journal-title":"J Clin Pharm Ther"},{"issue":"1","key":"pone.0282930.ref039","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1186\/s12871-021-01373-y","article-title":"Efficacy and safety of remimazolam besylate versus propofol during hysteroscopy: single-centre randomized controlled trial.","volume":"21","author":"X Zhang","year":"2021","journal-title":"BMC Anesthesiol."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0282930","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,3]],"date-time":"2023-08-03T13:42:13Z","timestamp":1691070133000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0282930"}},"subtitle":[],"editor":[{"given":"Ioannis","family":"Savvas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,8,3]]},"references-count":39,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,8,3]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0282930","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2023.02.28.23286563","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,3]]}}}