Remimazolam-Propofol and Propofol Induction Regimens for Pediatric Bidirectional Endoscopy: A Three-Arm…

Randomized trialChildren (Basel, Switzerland)· Aug 2026

Remimazolam-Propofol and Propofol Induction Regimens for Pediatric Bidirectional Endoscopy: A Three-Arm Randomized Trial.

Liming Cai, Zhengzheng Gao, Zeyang Wang … Xiumin Qin

Pediatric AnesthesiaRandomized trialTreatmentQ1IF 2.8

Low-dose remimazolam-propofol induction lowered respiratory depression risk versus propofol alone.

Remimazolam-Propofol and Propofol Induction Regimens for Pediatric Bidirectional Endoscopy: A Three-Arm Randomized Trial.

Liming Cai … Xiumin Qin

Children (Basel, Switzerland) · Aug 2026

Background

Propofol is effective for pediatric endoscopy but can depress ventilation.

Methods

This single-center, assessor-blinded randomized trial allocated children aged 6-12 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).

n = 120 children

Results

risk ratio of 0.19, respiratory depression far less likely with remimazolam-propofol

RR 0.19 (95% CI 0.09 to 0.37)

CI excludes the null - significant

More 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 < 0.001).

Mean time to eye opening was 12.7, 11.2, and 16.9 min, respectively.

More results

In the exploratory R1-versus-R2 comparison, time to eye opening was 5.75 min shorter with R1 (95% CI, 4.28-7.20).

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Conclusion · 1 of 2

Both remimazolam-propofol regimens reduced monitor-defined respiratory depression compared with propofol 3 mg/kg.

Conclusion · 2 of 2

The 0.2 mg/kg remimazolam-propofol 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.

Remimazolam-Propofol and Propofol Induction Regimens for Pediatric Bidirectional Endoscopy: A Three-Arm Randomized Trial.

Remimazolam-Propofol and Propofol Induction Regimens for Pediatric Bidirectional Endoscopy: A Three-Arm Randomized Trial.

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