{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:44:26Z","timestamp":1787071466668,"version":"build-2736575974"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 4","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,12]]},"abstract":"\n Background:<\/jats:title>\n Monitored anesthesia care (MAC) is increasingly utilized in diagnostic hysteroscopy to ensure patient comfort while maintaining safety. Among various agents, remifentanil and midazolam are commonly employed, but comparative data on their sedation quality and maternal\u2013fetal safety profiles during hysteroscopy in reproductive-age women remain limited.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n This prospective, randomized, controlled trial included 120 women undergoing diagnostic hysteroscopy. Participants were randomized into two groups: Group R (remifentanil infusion at 0.05\u20130.1 \u00b5g\/kg\/min) and Group M (midazolam bolus 0.05 mg\/kg followed by 0.02 mg\/kg as needed). Primary outcomes were sedation quality (Ramsay Sedation Score [RSS], patient and surgeon satisfaction), and secondary outcomes included hemodynamic stability, recovery time, and fetal safety indicators (serum \u03b2-hCG and uterine perfusion on Doppler ultrasonography pre- and post-procedure).<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Group R had significantly better sedation depth (RSS: 3.8 \u00b1 0.6 vs. 2.9 \u00b1 0.5,\n P<\/jats:italic>\n < 0.001), shorter recovery time (11.2 \u00b1 2.1 min vs. 24.7 \u00b1 3.6 min,\n P<\/jats:italic>\n < 0.001), and higher patient satisfaction (94.1% vs. 78.3%,\n P<\/jats:italic>\n = 0.018). Hemodynamic parameters remained stable in both groups. No significant difference was found in fetal safety markers (serum \u03b2-hCG:\n P<\/jats:italic>\n = 0.41; uterine perfusion index:\n P<\/jats:italic>\n = 0.57).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Remifentanil provides superior sedation quality and faster recovery without compromising maternal\u2013fetal safety compared to midazolam during MAC for diagnostic hysteroscopy. It is a viable alternative for short gynecological procedures in reproductive-age women.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/jpbs.jpbs_1355_25","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T08:00:46Z","timestamp":1766044846000},"page":"S3310-S3312","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Assessment of Sedation Quality and Maternal\u2013Fetal Safety Using Remifentanil versus Midazolam in Monitored Anesthesia Care during Diagnostic Hysteroscopy"],"prefix":"10.4103","volume":"17","author":[{"given":"Narayan Hari","family":"Sharma","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditya Singh","family":"Chauhan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Divya","family":"Sinha","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sourabh","family":"Shrivastava","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"key":"R1-20251218","first-page":"405","article-title":"Hysteroscopy for evaluating abnormal uterine bleeding","volume":"101","author":"Amini","year":"2020","journal-title":"Am Fam Physician"},{"key":"R2-20251218","first-page":"49","article-title":"Why epidurals do not always work","volume":"1","author":"Arendt","year":"2008","journal-title":"Rev 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remifentanil-midazolam combinations and their effects on postoperative cognitive functions in cystoscopies: A randomized clinical trial","volume":"18","author":"Arpaci","year":"2013","journal-title":"J Res Med Sci"},{"key":"R8-20251218","first-page":"165","article-title":"Pharmacokinetics and safety of midazolam: A review","volume":"20","author":"Wrobel","year":"2019","journal-title":"Curr Drug Metab"},{"key":"R9-20251218","first-page":"10","article-title":"Uteroplacental circulation during remifentanil anaesthesia: A Doppler study","volume":"32","author":"Chaudhry","year":"2017","journal-title":"Int J Obstet Anesth"},{"key":"R10-20251218","first-page":"1999","article-title":"Cost-effectiveness of remifentanil in outpatient anesthesia: Evidence from surgical suites","volume":"36","author":"Gupta","year":"2020","journal-title":"Curr Med Res Opin"}],"container-title":["Journal of Pharmacy and Bioallied Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/jpbs.jpbs_1355_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:46:32Z","timestamp":1787067992000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/jpbs.jpbs_1355_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":10,"journal-issue":{"issue":"Suppl 4","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/jpbs.jpbs_1355_25","relation":{},"ISSN":["0976-4879","0975-7406"],"issn-type":[{"value":"0976-4879","type":"print"},{"value":"0975-7406","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]},"assertion":[{"value":"2025-08-04","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-19","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}