Midazolam 20mg/0.5ml / Lidocaine 10mg/0.5ml nasal solution ampoules

BackgroundCombining lidocaine with bupivacaine in brachial plexus blocks seeks to blend rapid onset with extended duration; yet, clinical advantages are uncertain. This systematic review assesses their efficacy against bupivacaine alone in ultrasound-guided brachial plexus blocks.MethodsA systematic search of PubMed, EMBASE, and Cochrane databases was conducted in May 2025. Randomized controlled trials (RCTs) comparing lidocaine-bupivacaine mixtures with bupivacaine alone in ultrasound-guided brachial plexus blocks were included. The primary outcome was sensory block onset time. Secondary outcomes included motor block onset time, sensory and motor block durations, and conversion to general anesthesia. Data were analyzed using a random-effects model, with heterogeneity assessed via I² statistics.ResultsOf 1,490 identified articles, 7 RCTs (358 patients) met the inclusion criteria. No significant difference was found in sensory block onset time (mean difference [MD] -1.81 min, 95% confidence interval [CI] -3.92 to 0.29; P = 0.09; I² = 98%) or motor block onset time (MD 0.02 min, 95% CI -2.34 to 2.39; P = 0.99; I² = 95%) between groups. The mixture reduced sensory (MD -172.88 min, 95% CI -215.18 to -130.59; PConclusionsNo clinical benefit was observed from combining lidocaine with bupivacaine, as there was no improvement in block onset times and a reduction in block durations. Given the very low certainty of evidence, these findings should be interpreted with caution, and further high-quality RCTs are needed.

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BackgroundTherapeutic gastrointestinal endoscopy, including endoscopic retrograde cholangiopancreatography and endoscopic submucosal dissection, requires effective sedation strategies to ensure procedural success and patient safety. However, optimal pharmacological regimens remain unclear, particularly for prolonged procedures.MethodsWe searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for randomised controlled trials comparing pharmacological sedation strategies in patients undergoing therapeutic gastrointestinal endoscopy. Outcomes included procedural interference events, hypoxia, hypotension, bradycardia, recovery time, induction time, satisfaction, and postoperative nausea and vomiting. Risk of bias was assessed using the Cochrane RoB 2.0 tool, and certainty of evidence was rated using GRADE framework. A frequentist random-effects network meta-analysis was conducted, along with cluster ranking of co-primary outcomes to evaluate benefit-risk trade-offs.ResultsSixty randomised controlled trials involving 7,071 patients and 32 pharmacological regimens were included. Compared with propofol-opioid, which remained the reference standard, no regimen significantly reduced procedural interference events. Ketamine-propofol demonstrated consistent advantages across hypoxia (relative risk [RR] 0.12, 95% confidence interval [CI] 0.03 to 0.59, P = 0.009; moderate certainty), hypotension (RR 0.28, 95% CI 0.09 to 0.83, P = 0.021; low certainty), and bradycardia (RR 0.11, 95% CI 0.01 to 0.86, P = 0.035; moderate certainty). Cluster rank analyses identified ketamine-propofol and lidocaine-midazolam-propofol as the highest-ranking regimens in both efficacy and safety domains. Meta-regression revealed no significant effect modifiers.ConclusionWhile propofol-opioid remains the standard reference, alternative sedation strategies such as ketamine-propofol and lidocaine-midazolam-propofol offer favourable profiles for therapeutic gastrointestinal endoscopy. These findings support individualised regimen selection based on patient and procedural needs.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251018215.

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PurposeThe selection of sedatives for bronchoscopy procedures remains debated. This study evaluates the safety of intravenous midazolam, propofol, dexmedetomidine, and remimazolam as sedative agents during flexible bronchoscopy.Materials and methodsWe conducted a Bayesian network meta-analysis (NMA) using PubMed, Embase, and the Cochrane Central Register. Between-group comparisons were estimated using odds ratios (ORs) with 95% credible intervals (95% CIs). Surface under the cumulative rank curve (SUCRA) plots were produced. The rate of hypoxemia was the primary outcome.ResultsTwenty-four randomized controlled trials involving 4010 patients were included. Baseline variables were generally well balanced across sedative agents in the transitivity analysis, and the node-splitting approach demonstrated a high degree of concordance among the comparisons. The NMA results indicate that remimazolam was significantly associated with a lower rate of hypoxemia than midazolam (OR 0.36, 95% CI 0.18 to 0.79) and propofol (OR 0.33, 95% CI 0.16 to 0.69). Based on their SUCRA values, the ranking of the four sedative agents from most to least favorable was intravenous remimazolam, followed by dexmedetomidine, midazolam, and propofol. The probability of intravenous remimazolam being the most effective treatment was 93.4%. The SUCRA values also showed that midazolam had the lowest risk of hypotension (79.6%), and propofol had the lowest risk of bradycardia (90.4%).ConclusionThese NMA findings suggest that, in terms of reducing the risk of hypoxemia, intravenous remimazolam is the safest sedative agent for patients undergoing bronchoscopy.

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PurposeSafe and effective sedation are important factors when performing gastrointestinal endoscopy. However, clinicians should be cautious when using sedatives in older patients because of their decreased physiological reserves. Remimazolam is an ultrashort active benzodiazepine that has attracted attention because of its efficacy. This study aimed to determine the safety and efficacy of remimazolam compared with midazolam as a sedative for diagnostic upper gastrointestinal endoscopy in older patients aged ≥ 65 years.MethodsWe randomly assigned patients aged ≥ 65 years who were scheduled for diagnostic upper gastrointestinal endoscopy. The average induction time, average recovery time, and side effect profile of patients who received remimazolam as a sedative were compared with those of patients who received midazolam.ResultsA total of 120 patients underwent randomization (60 in the remimazolam group and 60 in the midazolam group). Patients who received remimazolam had shorter average induction (mean ± standard deviation, 102.0 ± 77.2 s vs. 327.5 ± 125.3 s, p ConclusionsIn performing upper gastrointestinal endoscopy in older patients, remimazolam can be a good alternative sedative to midazolam, whether used as monotherapy or in combination therapy.

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PurposeRemimazolam is an ultrashort-acting benzodiazepine, which has been indicated to be effective in endoscopic surgery and general anaesthesia. Research on its use in outpatient dental procedures remains limited. This triple-blinded randomized clinical trial was designed to determine whether the quality of postoperative recovery is better with continuous intravenous remimazolam administration compared with midazolam administration for impacted wisdom tooth extraction in patients with dental anxiety.Patients and methodsThis study was a randomized, parallel triple-blinded, superiority trial conducted between 30 April 2022 and 24 June 2024. Participants aged ≥18 years who exhibited dental anxiety and who were eligible for impacted wisdom tooth extraction in an outpatient setting were included in this study. Participants were randomly assigned at a 1:1 ratio to receive either a continuous intravenous infusion of remimazolam or midazolam. The primary outcome was the time to recover full alertness. The secondary outcome was postoperative anterograde amnesia.ResultsA total of 150 participants were randomized in this study, with 75 patients assigned to the remimazolam group and 75 patients assigned to the midazolam group. The time to complete alertness was significantly shorter in the remimazolam group than in the midazolam group (3.0 ± 3.6 min vs 4.7 ± 5.2 min, mean difference, -1.9 min; 95% CI, -3.3min to -0.4 min; P = 0.013). The odds of immediate and delayed anterograde amnesia were much reduced with remimazolam administration compared with midazolam administration (immediate: 0.14, 95% CI, 0.05 to 0.34, delayed: 0.07, 95% CI, 0.03 to 0.15, both P ConclusionFor patients with dental anxiety, remimazolam offers not only faster recovery, but also a much better restoration of memory function compared with midazolam.Trial registrationhttps://clinicaltrials.gov/study/NCT05350085.

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BackgroundFiberoptic bronchoscopy has developed rapidly as a routine test, especially it played an important role during the COVID-19. The suitable options for moderate sedation medications is necessary. The present study aimed to observation the feasibility and safety of remimazolam in geriatric patients undergoing fiberoptic bronchoscopy.MethodsThis study is a single-center, randomized, parallel controlled trial conducted on patients undergoing fiberoptic bronchoscopy at the Hangzhou First People's Hospital, School of Medicine, Westlake University. A total of 105 geriatric patients undergoing fiberoptic bronchoscopy were divided into 3 groups (n=35) randomly. Group A (remimazolam + fentanyl + local anesthesia); Group B (midazolam + fentanyl + local anesthesia); Group C (local anesthesia).The primary outcomes include all patients' vital signs(Heart rate,non-invasive blood pressure,saturation of pulse oximetry,end-tidal carbon dioxide, bispectral index, respiratory rate), Modified Observer's Alertness/Sedatio and the rate of adverse events. Secondary outcomes are onset time of the drug, operation time , recovery time, operator and patient's satisfaction.ResultsThis study enrolled a total of 105 patients, among them 97 were actually included in the statistics(34 in group A, 30 in group B, and 33 in group C). Compared with group C, the vital signs in group A and B are more stable at T1, T2, T3, and T4 times(PConclusionsIn our study, we found that an intravenous injection of remimazolam at 0.2 mg/kg, combined with fentanyl at 0.5 μg/kg for sedation, along with local anesthesia of the pharynx and tracheal mucosa, and supplemental anesthesia with fentanyl 25 μg every 5 to 10 minutes if necessary, is effective and safe for geriatric patients during fiberoptic bronchoscopy.Trial registrationThis study was registered with the Chinese clinical trial registry. ChiCTR2100047459,the Registration Date is 2021/06/19.

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BackgroundThis study aimed to compare the efficacy and safety of lidocaine-based patient-controlled intravenous analgesia (PCIA) with sufentanil-based PCIA for managing postoperative pain in patients undergoing laparoscopic colorectal cancer surgery.MethodsA total of 126 patients were randomly assigned in a 1:1 ratio to lidocaine group (group L, n = 63) or the sufentanil group (group S, n = 63). The primary endpoint was visual analogue scale (VAS) pain score during movement at 24 h after surgery. Secondary endpoints included VAS pain scores at rest and during movement at 6, 12, 36, and 48 h after surgery, the time of first flatus and defecation after the surgery, postoperative hospitalization time and total hospitalization costs, patient satisfaction scores, and the incidence of adverse events.ResultsThere was no significant difference between the two groups in VAS pain scores at rest and during movement at 6, 12, 24, 36, and 48 h after surgery (all p > 0.05). The time to first flatus and defecation, as well as postoperative hospitalization time and total hospitalization expenses, were also similar between the two groups (all p > 0.05). However, satisfaction score was significantly higher in group L compared to group S (p ConclusionsLidocaine-based PCIA can effectively relieve postoperative pain, decrease the incidence of PONV, and improve patient satisfaction in patients undergoing laparoscopic colorectal cancer surgery.Trials registrationThe study was registered on the Chinese Clinical Trial Registry (ChiCTR) with the registration number ChiCTR2300068854, with the registration date being March 1, 2023.

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