{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T02:28:38Z","timestamp":1786328918312,"version":"build-2736575974"},"reference-count":24,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T00:00:00Z","timestamp":1786147200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Propofol is effective for pediatric endoscopy but can depress ventilation. We compared three induction regimens in school-aged children undergoing bidirectional gastrointestinal endoscopy. Methods: This single-center, assessor-blinded randomized trial allocated children aged 6\u201312 years (1:1:1) to propofol 3 mg\/kg (P), remimazolam 0.2 mg\/kg plus propofol 1 mg\/kg (R1), or remimazolam 0.4 mg\/kg plus propofol 1 mg\/kg (R2). All groups received sufentanil and standardized propofol maintenance. Respiratory depression was a respiratory rate &lt; 10 breaths\/min or peripheral oxygen saturation &lt; 90% for &gt;1 min. The trial was prospectively registered (ChiCTR2500096218), and analysis followed assigned groups. Results: The analysis included 120 children (40 per group). Respiratory depression occurred in 32\/40 (80.0%) in P, 6\/40 (15.0%) in R1, and 14\/40 (35.0%) in R2 (overall p &lt; 0.001). Compared with P, the risk difference was \u221265.0 percentage points for R1 (95% confidence interval [CI], \u221277.4 to \u221244.6; risk ratio, 0.19; 95% CI, 0.09\u20130.37) and \u221245.0 percentage points for R2 (95% CI, \u221261.0 to \u221223.6; risk ratio, 0.44; 95% CI, 0.27\u20130.66); both Holm-adjusted p values were &lt;0.001. Mean time to eye opening was 12.7, 11.2, and 16.9 min, respectively. In the exploratory R1-versus-R2 comparison, time to eye opening was 5.75 min shorter with R1 (95% CI, 4.28\u20137.20). Conclusions: Both remimazolam\u2013propofol regimens reduced monitor-defined respiratory depression compared with propofol 3 mg\/kg. The 0.2 mg\/kg remimazolam\u2013propofol regimen combined this respiratory benefit with faster recovery than the 0.4 mg\/kg regimen in exploratory analysis, supporting its further evaluation as an induction strategy for pediatric bidirectional endoscopy.<\/jats:p>","DOI":"10.3390\/children13081056","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T01:20:03Z","timestamp":1786324803000},"page":"1056","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Remimazolam\u2013Propofol and Propofol Induction Regimens for Pediatric Bidirectional Endoscopy: A Three-Arm Randomized Trial"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8205-8481","authenticated-orcid":false,"given":"Liming","family":"Cai","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, National Center for Children\u2019s Health, Beijing Children\u2019s Hospital, Capital Medical University, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengzheng","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Center for Children\u2019s Health, Beijing Children\u2019s Hospital, Capital Medical University, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3677-1288","authenticated-orcid":false,"given":"Zeyang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Center for Children\u2019s Health, Beijing Children\u2019s Hospital, Capital Medical University, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoxue","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Center for Children\u2019s Health, Beijing Children\u2019s Hospital, Capital Medical University, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Center for Children\u2019s Health, Beijing Children\u2019s Hospital, Capital Medical University, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Hua","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Center for Children\u2019s Health, Beijing Children\u2019s Hospital, Capital Medical University, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenya","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Center for Children\u2019s Health, Beijing Children\u2019s Hospital, Capital Medical University, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lanxin","family":"Qiao","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Center for Children\u2019s Health, Beijing Children\u2019s Hospital, Capital Medical University, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianmin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Center for Children\u2019s Health, Beijing Children\u2019s Hospital, Capital Medical University, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5195-6270","authenticated-orcid":false,"given":"Lijing","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Center for Children\u2019s Health, Beijing Children\u2019s Hospital, Capital Medical University, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5851-6622","authenticated-orcid":false,"given":"Fang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, National Center for Children\u2019s Health, Beijing Children\u2019s Hospital, Capital Medical University, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiumin","family":"Qin","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Digestive Endoscopy Center, National Center for Children\u2019s Health, Beijing Children\u2019s Hospital, Capital Medical University, Beijing 100045, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"106604","DOI":"10.4253\/wjge.v17.i6.106604","article-title":"Sedation in endoscopy: Current practices and future innovations","volume":"17","author":"Bruni","year":"2025","journal-title":"World J. 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