Introduction
ERCP is typically performed with midazolam/opiate sedation, however, this combination is associated with adverse events including oversedation, cardiorespiratory depression, procedural failure and prolonged recovery. This study evaluates a novel protocol using remimazolam and enhanced recovery principles.
Methods
A prospective study was performed between November 2022 and January 2025 before and after the introduction of a novel sedation protocol using remimazolam and enhanced recovery techniques. Safety, key performance indicators of procedural success, time from procedure to discharge, hospital length of stay, and concomitant fentanyl use were compared in the novel (remimazolam) and traditional (midazolam) protocol groups.
Results
79 patients were identified in the midazolam cohort and 191 patients in the remimazolam cohort. Procedural success measured by bile duct cannulation, stone extraction and stricture stenting showed trends towards better success with remimazolam compared to midazolam (88% vs. 85.2%, 82.6% vs. 79.8% and 88.2% vs. 80.0%, respectively). Complications were similar in remimazolam and midazolam groups (4.6% vs. 4.9%). Concomitant fentanyl use was lower in the remimazolam group (mean dose 101mg vs. 128mg). Time from procedure to discharge in day cases was shorter in the remimazolam group (228 minutes vs. 336 minutes, P<0.001) and post-procedure length of stay was shorter in the remimazolam group (median 1.7 days, vs. 3.0 days, P=0.3). Day case rates were similar in both groups (54% vs. 53%)
Conclusions
A novel sedation protocol including the use of remimazolam with an enhanced recovery pathway is associated with improved clinical outcomes compared to a traditional midazolam sedation protocol.
Authors
David Bunting
Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, United Kingdom