Year: 2026
Type: conference-abstract
Abstract: BackgroundProviding safe sedation for gastrointestinal endoscopy in high-risk patients remains challenging, particularly in non-operating room anesthesia (NORA) settings, where respiratory complications may rapidly compromise procedural safety.Remimazolam, an ultra-shortacting benzodiazepine, has emerged as a promising sedative due to its favorable hemodynamic and respiratory profile.In frail patients, systematic use of High-Flow Nasal Cannula (HFNC) may improve oxygenation and reduce peri-procedural respiratory events.This preliminary observational study evaluated the feasibility and safety of a sedation strategy combining remimazolam and HFNC in high-risk patients undergoing gastrointestinal endoscopy. Materials and MethodsWe enrolled forty-one adult patients with ASA physical status III scheduled for gastroscopy, colonoscopy or combined procedures after informed consent.13 patients were older than 65 years, 18 had cardiovascular disease, 7 had chronic pulmonary disease, 15 were active or former smokers, 9 had class I obesity (BMI >30), and 1 had class II obesity (BMI >35).Sedation was induced with remimazolam 5 mg followed by 2.5 mg boluses, up to a cumulative dose of 20 mg.Due to the elevated respiratory risk, HFNC was routinely applied throughout the procedures at 40 L/min, FiO2 50% at a temperature of 31 °C.Supplemental propofol boluses (20-30 mg) and fentanyl 50 mcg were administered when clinically required. ResultsRemimazolam alone provided adequate sedation in 16 procedures lasting up to 20 minutes.In the remaining 25 cases, additional propofol was required, mainly during longer or technically demanding procedures, including combined procedures, polypectomy, biopsy sampling and procedures performed by less experienced operators.Fentanyl was administered in 10 patients, while flumazenil 0.5 mg was used in 9 cases to facilitate recovery.All procedures were successfully completed in the NORA setting with rapid recovery; most patients were awake, cooperative and hemodynamically stable within 20 minutes.Only one adverse event occurred: a 78-year-old woman with cardiovascular disease developed severe bradycardia, hypotension and mild desaturation requiring atropine, HFNC flow escalation and temporary interruption of the procedure.No further complications were observed. ConclusionsThe combination of remimazolam and HFNC appears to be a feasible and effective sedation strategy for high-risk patients undergoing gastrointestinal endoscopy in NORA settings.HFNC may represent a valuable adjunctive respiratory support tool, contributing to procedural safety, maintenance of adequate oxygenation throughout the procedure and rapid recovery.The study is currently under review by the local Ethics Committee.
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,079
OpenAlex ID: W7222940845