Clinical trial NCT06258356: Remimazolam in High Risk ERCP Patients
Official title: Exploring the Use of Remimazolam (BYFAVO®) in Patients at High Risk for ERCP to Reduce Intraoperative Hypotension and Assess Safety and Efficacy: A Randomized Controlled Trial
Study type: INTERVENTIONAL
Overall status: NOT_YET_RECRUITING
Phase: NA
Conditions: the Severity and Duration of Intraoperative Hypotension
Lead sponsor: National Taiwan University Hospital
Sponsor class: OTHER
First posted: 2024-02-14
Enrollment: 60
Sex: ALL
Minimum age (years): 20
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: One patients receiving Remimazolam, the other patients receiving placebo
Primary purpose: OTHER

Brief summary: We conducted a randomized trial to investigate whether the administration of Remimazolam in patients undergoing high-risk endoscopic retrograde cholangiopancreatography (ERCP) could significantly reduce the occurrence of intraoperative hypotension, facilitate rapid induction, and result in fewer associated complications.

Detailed description: Remimazolam is a novel ultra-short-acting benzodiazepine-like anesthetic used for gastrointestinal endoscopic procedures, characterized by predictable sedation duration and rapid recovery. Propofol, commonly used in clinical practice as an intravenous anesthetic, also exhibits rapid onset, short duration, and quick recovery characteristics. To date, there is relatively limited literature comparing the likelihood of intraoperative hypotension during general anesthesia with these two agents in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Additionally, a comparison is needed regarding the frequency of additional sedative doses required during anesthesia induction and the occurrence of major postoperative complications, including pancreatitis.

Therefore, the investigators we conducted a randomized trial to investigate whether the administration of Remimazolam in patients undergoing high-risk ERCP could significantly reduce the occurrence of intraoperative hypotension, facilitate rapid induction, and result in fewer associated complications. The investigators aimed to enroll 60 patients with a 1:1 ratio of ASA III to IV undergoing ERCP. The investigators anticipate that Remimazolam can reduce intraoperative hypotension, acute postoperative pancreatitis, and the occurrence of major organ complications.

Eligibility criteria: Inclusion Criteria:

* Male and female subjects aged between 20 and 90 years old;
* ASA (American Society of Anesthesiologists) class III to IV;
* Body Mass Index (BMI) between 18 and 30 kg/m².

Exclusion Criteria:

* Uncontrolled hypertension or hypotension, or clinically significant coronary artery atherosclerosis heart disease or heart failure;
* Severe respiratory system disorders;
* Severe sinus bradycardia, heart conduction block, frequent ventricular arrhythmias, or atrial fibrillation;
* Clinically significant coagulation disorders;
* End-stage liver failure or kidney disease requiring dialysis;
* Emergency surgery;
* Peripheral artery disease with upper limb functional impairment;
* Other conditions deemed inappropriate by the investigator, including patients with superficial pharyngeal cancer for whom rapid extubation is not suitable during ERCP.

Primary outcomes:
measure: the duration and severity of hypotension checklist
timeFrame: 1 day (during the ERCP examination)
Secondary outcomes:
Other outcomes:
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