Feasibility and safety evaluation of remimazolam tosylate in geriatric patients during bronchoscopy ： A single-centre randomized controlled trial

Feasibility and safety evaluation of remimazolam tosylate in geriatric patients during bronchoscopy ： A single-centre randomized controlled trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Feasibility and safety evaluation of remimazolam tosylate in geriatric patients during bronchoscopy ： A single-centre randomized controlled trial Yaqin Huang, Yang Yu, Weiping Lei, Jianliang Sun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4589360/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 13 Oct, 2025 Read the published version in BMC Anesthesiology → Version 1 posted 4 You are reading this latest preprint version Abstract Background: Fiberoptic 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 evaluate the feasibility and safety of remimazolam tosylate in geriatric patients undergoing fiberoptic bronchoscopy. Methods This study is a single-center randomized controlled trial. A total of 105 geriatric patients undergoing fiberoptic bronchoscopy were divided into 3 groups (n=35) randomly. Group A (remimazolam group); Group B (midazolam group); in Group C (control group). Record the all patients’ vital signs and the rate of adverse events. Results A total of 105 patients were enrolled and 97 actual patients (34 patients in group A, 30 patients in group B, and 33 patients in group C) were analyzed in the end. Compared with group C, the vital sign in group A and B are more stable at T1, T2, T3, and T4 (P<0.05).The frequency of hypertension in group A and group B was significantly lower than that in group C(P<0.05). Compared with group B, the onset time and recovery time of group A were shortened (both P<0.05). The satisfaction of patients and operators in group A and group B was higher than that in group C (P<0.05). Conclusions In the sduty we found that intravenous injection of remazolam tosylate 0.2 mg/kg, fentanyl 0.5 μg/kg for sedation, and additional anesthesia with fentanyl 25 μg every 5 to 10 minutes if necessary is effictive and safe for geriatricpatients during fiberoptic bronchoscopy . Trial registration: This study was registered with the Chinese clinical trial registry (ChiCTR2100047459),the Registration Date is 2021/06/19. bronchoscopy remimazolam tosylate geriatric patients anesthesia management Figures Figure 1 INTRODUCTION Fiberoptic bronchoscopy (FB, referred to as fiberoptic bronchoscopy) is an important means of diagnosis and treatment of airway diseases, lung infections, malignant tumors, diffuse lung diseases and other respiratory diseases currently. However, as an invasive operation, FB strongly stimulates the airway during the examination which causing great pain to patients and even causing complications such as bleeding, laryngeal spasm, pneumothorax, infection, hypoxemia, arrhythmia, hypertension and cerebrovascular accident [1,2] . Therefore, the FB examination process is often forced to pause several times during the routine general tracheal mucosal surface anesthesia, which significantly affects the quality and safety of the FB examination. Therefore, it is urgent to find a safe, effective and comfortable sedation/analgesia or anesthesia method for FB examination. At present, general anesthesia and moderate sedation are common used for clinical painless FB diagnosis and treatment. For moderate sedation, propofol,midazolam, remifentanil, fentanyl and dexmedetomidine are often used for mid-depth sedation and analgesia. These drugs depress respiration or circulation to varying degrees,or have long half-life, that restrict theirs using. Patients who undergoing FB are often older or have respiratory system complications, resulting in poor oxygen reserve and oxygenation disorders,etc. Therefore,the moderate sedation medications which is mild respiratory circulation suppression, rapid induction and recovery, and is suitable for elderly patients of relatively insufficient cardiopulmonary function reserve still needs further clinical research. Remimazolam tosylate is an ester-based benzodiazepine derivative that acts on γ-aminobutyric acid type A (GABAA) receptors and has the pharmacological properties of classic benzodiazepines (such as midazolam). Unlike other benzodiazepines, it can be rapidly hydrolyzed by esterase; compared with other intravenous sedative drugs (such as propofol), its advantages include slight respiratory depression, stable hemodynamics, low incidence of intravenous pain, and there is no accumulation in the body [ 3 ]. Remimazolam tosylate is rapidly metabolized by non-specific esterases in the body and independ on liver and kidney functions. The pharmacokinetics is linear, and the time-dosage-related half-life (CSHT) is not affected by the infusion time. Metabolites have little pharmacological activity and its effects can be rapidly reversed by flumazenil [ 4 ]. Based on the above-mentioned characteristics of remimazolam tosylate, some studies have applied it to painless diagnosis and treatment such as gastrointestinal endoscopy and hysteroscopy. The purpose of this study is to observe and evaluate the safety and feasibility of clinical application of remimazolam tosylate in geriatric patients undergoing fiberoptic bronchoscopy. MATERIALS AND METHODS Patients The RCT was conducted at the Hangzhou First People’s Hospital,School of Medicine,Westlake University,following approval by the Ethics Committee (2020YLSD003- 01) and was registered with the Chinese clinical trial registry (ChiCTR2100047459).A total of 105 elderly patients who underwent bronchofiberoscopy were enrolled in this study and all participants signed the informed consent form. The inclusion criteria were as follows: (1) patients with an American Society of Anesthesiologists (ASA) class I or II (2)Geriatric patients with respiratory diseases undergoing elective FB treatment (routine bronchoscopy and some simple FB treatments including transbronchial needle aspiration biopsy, transbronchial brushing, and bronchoalveolar lavage);(3)age 60 ~ 80 years old;(4)body mass index 30min;(2)patients with neuropsychiatric diseases and taking related drugs;(3) patients with target organ damage such as liver, kidney, heart and brain; (4)patients with allergies to anesthetic drugs;(5) those who cannot cooperate with doctors;(6) Patients with or uncontrolled hypertension, heart disease, diabetes and other diseases. Grouping The patients were randomly assigned to three groups (n = 35 each) using a list of numbers generated by the QuickCalcs (GraphpadPrism 7):Group A (remimazolam tosylate group): intravenous injection of remazolam 0.2 mg/kg and fentanyl 0.5 µg/kg for sedation; Group B (midazolam group): intravenous injection of midazolam 0.075mg/kg and fentanyl 0.5 µg/kg for sedation ; and an additional dose with fentanyl 25 µg every 5 to 10 minutes for the either group if necessary; Group C (control group): routine tracheal mucosal. The group assignment numbers were sealed in an envelope, and opened once written informed consent was obtained.As illustrated in Fig. 1 . Experimental Protocols The patients were instructed to fast before the operation. Electrocardiogram (ECG), heart rate (HR), non-invasive blood pressure (BP), saturation of pulse oximetry (SpO 2 ), end-tidal carbon dioxide (PetCO 2 ) and bispectral index (BIS) were monitered in the operating room with the patient in supine position. Group A was inducted by intravenous injection of remimazolam tosylate 0.2mg/kg and fentanyl 0.5µg/kg for sedation/analgesia. Group B was inducted by intravenous injection of midazolam 0.075mg/kg and fentanyl 0.5µg/kg for sedation/analgesia. Group C was performed by spraying 2% lidocaine on the surface of tracheal mucosa without any other special treatment. The endoscopic operation process was completed by an experienced respiratory physician. Each patient was assisted with local anesthesia with 2% lidocaine mucosal surface spraying when the fiberoptic bronchoscope first entered the glottis, carina, and left and right bronchus, and then fiberoptic bronchoscopy was performed. When the Modified Observer’s Alertness/Sedation (MOAA/S) score was ≤ 3, bronchoscopy was started. If persistent coughing occurs during the operation and body movement affects the operation of the operator, 25 µg of fentanyl can be added every 5 to 10 minutes until achived a maximum of 200 µg. It was designated a treatment failure if the dgree of sedation still insufficient to operation. Every patient was sent to the post-anesthesia care unit (PACU) after operation. Patients can exit PACU untill regained consciousness and completed command actions, recover orientation ability, and raise the head while supine for more than 10 seconds. HR, BP, MAP, SpO2, PetCO2, BIS were recorded when the patient was awake while breathing room air before anesthesia (T0), the post-anesthesia induction state (T1) under nasal cannula oxygen inhalation (oxygen flow rate 3-5L/min), the time when the bronchoscope was inserted into the glottis (T2), the postoperative at the time of completion (T3) and when the patient wakes up (T4). Record the onset time of the drug, operation time (the time from the beginning of insertion of the bronchoscope to the completion of the insertion), and recovery time (have command action, recovery of orientation ability, time to raise the head in supine position > 10s).Intraoperative coughing, hypoxemia, and other adverse events (including blood pressure fluctuation > 20% before anesthesia, heart rate 120 beats/min, arrhythmia, larynx or bronchospasm, etc.) were recorded. Assessment of surgeon satisfaction (excellent: the opening of the glottis is excellent; good: the opening of the glottis is good, the mirror placement is smooth, and the patient's cooperation is good; poor: the opening of the glottis is not good, there is obvious body movement or coughing, which leads to mirror withdrawal affecting the operator's operation),patient's satisfaction (satisfactory/general/unsatisfactory). Record the MOAA/S scores of groups A and B at each time point from T0 to T4: 5 points - Responds readily to name spoken in normal tone; 4 points - Lethargic response to name spoken in normal tone; 3 points - Responds only after name is called loudly and/or repeatedly; 2 points - Responds only after mild prodding or shaking; 1 point - Responds only after painful trapezius squeeze; 0 point - Does not respond to painful trapezius squeeze. Statistical Analysis The sample size for calculating the difference in recovery time between the two groups was determined using G-power (version 3.1.9.2, α = 0.05, power = 0.8) depending on our preliminary study results (intervention group: mean = 2.26, SD = 2.08; control group: mean = 4.25, SD = 3). A total of 28 patients were required per group, and considering an expulsion rate of 0.2, the sample size was increased to 35 patients per group. All variables were expressed as numbers, mean (SD) or median (interquartile range). Statistical analysis was performed using the SPSS25.0 Software and the measurement data was normally distributed using the Shapiro-Wilk test. The normally distributed measurement data were expressed as mean ± standard deviation (X ± s), and the comparison between groups was analyzed by one-way ANOVA, and the Bonferroni multiple comparison test was performed, and the Welch test was used for heterogeneity of variance. Non-normally distributed continuous variables were expressed as medians (interquartile ranges), and analyzed using nonparametric tests (Kruskal-Wallis H test). Counting data were compared using chi-square test or Fisher test, and Bonferroni correction test was used. Bilateral P < 0.05 was considered statistically significant. RESULTS According to the inclusion and exclusion criteria, a total of 105 patients were enrolled in this study. Among them, the data of 3 cases were missing, 4 patients refused to enter the group, and 1 case changed the anesthesia method, so they were excluded from the study. Finally, the data of 97 patients were analyzed statistically (Fig. 1 ).The general data of the three groups of patients are showed in Table 1 . There were no significant differences in age, sex, ASA classification, weight, height, and BMI among the three groups (all P < 0.05, Table 1 ).Compared with group C, the operation time in group B was significantly shortened, and the difference was statistically significant (P < 0.05).Compared with group B, the onset time and recovery time of group A were shortened (P < 0.05). There was no statistical significance in the number of additional drugs in group A and B. Table 1 Demographic characteristics and clinical data of three group Group A (n = 34) Group B (n = 30) Group C (n = 33) P -value Age(years) (mean ± SD) 54.65 ± 13.23 57.37 ± 12.36 57.00 ± 13.50 0.658 Gender,n(%) (male/female) 22/12(64.7/35.3) 18/12(60/40) 24/9(72.7/27.3) 0.565 ASA PS,n(%) (Ⅰ/Ⅱ) 7/27(20.6/79.4) 3/27(10/90) 7/26(21/79) 0.434 Weight(kg) (mean ± SD) 61.60 ± 12.73 62.18 ± 12.99 60.89 ± 8.53 0.906 Height(cm) (mean ± SD) 165.91 ± 7.29 163.27 ± 7.44 163.00 ± 6.33 0.18 BMI(kg/m 2 ) (mean ± SD) 22.26 ± 3.65 23.20 ± 3.73 22.95 ± 3.19 0.543 Onset time (min) 2.46 ± 0.83 4.80 ± 1.03 -- 0.000 Operation time (min) 22.79 ± 9.88 19.57 ± 7.42 26.00 ± 11.28 0.021 Recovery time (min) 0.25 ± 0.73 2.03 ± 2.31 -- 0.000 The number of additional drugs 0.24 ± 0.44 0.13 ± 0.35 -- 0.275 ASA PS: the American Society of Anesthesiologists physical status;BMI: body mass index. The comparison of the vital signs of the three groups at different time points is shown in Table 2 .There was no significant difference in the mean arterial pressure of the three groups after entering the room and breathing room air before anesthesia. Compared with group C, MAP in group A decreased significantly at each time point of T1, T2, T3, and T4 (P < 0.05) and the difference was statistically significant. Compared with group B, MAP in group A decreased significantly at T1 and T2 time points. Compared with group C, MAP in group B decreased significantly at T3 and T4 time points. Compared with group C, HR in group A decreased significantly at T3 and T4 time points. There was no significant difference in SpO2 and PetCO2 at T0, T1, T2, T3, and T4 time points among the three groups of patients. There was no significant difference in BIS between the two groups at T0, T1, T2, T3, and T4 time points. Compared with group C, the RR in group A was significantly lower at each time point of T2, T3 and T4. Compared with group C, the RR in group B was significantly lower at each time point of T2, T3, and T4. The average range values ​(highest value-lowest value) of MAP, HR, BIS, and RR in group A were smaller than those in group B showed in Table 3 . There was no statistical significance in the MOAA/S scores of the two groups at each time point from T0 to T4(Table 4 ). Table 2 The vital signs of the three groups at different time points Group T0 T1 T2 T3 T4 MAP(mmHg) A (n = 34) 81.05 ± 11.68 74.17 ± 12.52 71.84 ± 9.07 77.23 ± 11.87 76.43 ± 12.32 B (n = 30) 78.72 ± 15.87 86.62 ± 14.64 84.07 ± 19.93 82.86 ± 17.52 81.53 ± 13.38 C (n = 33) 83.34 ± 16.41 83.34 ± 16.41 90.34 ± 23.35 92.77 ± 17.43 92.77 ± 17.43 P -value 0.465 0.003 0.000 0.000 0.000 HR(bpm) A (n = 34) 80.65 ± 10.15 88.68 ± 11.23 87.06 ± 12.63 88.03 ± 12.86 85.29 ± 10.34 B (n = 30) 81.53 ± 16.39 93.00 ± 16.81 93.03 ± 17.37 94.07 ± 18.35 94.00 ± 18.35 C (n = 33) 84.45 ± 17.57 84.45 ± 17.57 94.42 ± 18.12 100.21 ± 17.22 100.21 ± 17.22 P -value 0.558 0.094 0.146 0.011 0.001 SpO 2 (%) A (n = 34) 99.06 ± 1.35 98.26 ± 2.51 98.35 ± 1.82 98.29 ± 2.32 98.65 ± 1.54 B (n = 30) 98.93 ± 1.20 98.80 ± 1.24 98.47 ± 1.63 98.27 ± 1.86 98.63 ± 1.65 C (n = 33) 98.73 ± 1.46 98.73 ± 1.46 98.42 ± 1.94 97.55 ± 2.49 97.55 ± 2.49 P -value 0.532 0.903 0.849 0.282 0.101 BIS A (n = 34) 95.35 ± 2.25 65.35 ± 13.69 72.71 ± 11.03 87.56 ± 5.56 91.62 ± 5.14 B (n = 30) 93.60 ± 3.53 59.67 ± 10.80 71.13 ± 12.31 86.57 ± 7.56 91.57 ± 3.69 P -value 0.087 0.075 0.558 0.898 0.347 PetCO 2 (mmHg) A (n = 34) 37.44 ± 2.79 37.56 ± 1.99 38.18 ± 2.96 37.56 ± 3.33 38.47 ± 3.15 B (n = 30) 38.17 ± 2.29 37.73 ± 1.95 37.97 ± 2.16 36.90 ± 2.95 38.43 ± 2.60 C (n = 33) 37.85 ± 1.18 37.85 ± 1.18 37.58 ± 1.56 37.79 ± 1.41 37.79 ± 1.41 P -value 0.742 0.527 0.731 0.550 0.248 RR(bpm) A (n = 34) 17.21 ± 3.10 17.32 ± 2.33 17.91 ± 2.22 17.44 ± 2.63 17.59 ± 3.17 B (n = 30) 17.33 ± 2.75 17.63 ± 2.24 17.80 ± 2.23 17.73 ± 2.42 17.53 ± 3.22 C (n = 33) 18.70 ± 1.72 18.70 ± 1.72 19.58 ± 1.87 19.82 ± 1.79 19.82 ± 1.79 P -value 0.712 0.025 0.001 0.000 0.001 T0: before anesthesia; T1:the post-anesthesia induction state;T2:the time when the bronchoscope was inserted into the glottis;T3:the postoperative at the time of completion;T4:when the patient wakes up. MAP:mean blood pressure;HR:heart rate;BIS:bispectral index;SpO2: pulse oximeter oxygen saturation;PetCO 2 :End-tidal carbon dioxide partial pressure;RR:respiratory rate. Table 3 Comparison of the mean range values Group MAP(mmHg) HR(bpm) BIS RR(bpm) A (n = 34) 14.03 11.79 24.32 2.15 B (n = 30) 22.7 12.17 29.53 2.4 The average range values(highest value-lowest value) of MAP, HR, BIS, and RR Table 4 MOAA/S at each time point among the three groups Group MOAA/S T0 T1 T2 T3 T4 A (n = 34) 5.00 ± 0.00 4.76 ± 0.43 4.35 ± 0.81 4.12 ± 0.69 4.88 ± 0.33 B (n = 30) 5.00 ± 0.00 4.93 ± 0.25 4.46 ± 0.57 4.10 ± 0.61 4.90 ± 0.31 P -value - 0.065 0.525 0.914 0.825 MOAA/S :Modified Observer’s Assessment of Alertness/Sedation Scale. The comparison of adverse events, operator satisfaction and patient satisfaction among the three groups are shown in Table 5 . There was no significant difference in tachycardia, arrhythmia, hypoxemia among the three groups (P < 0.05). The incidence of hypertension and coughing in group A and group B was significantly lower than that in group C, but body movement increased compared with group C, and the difference was statistically significant (both P < 0.05). The patient satisfaction and operator satisfaction in groups A and B were higher than those in group C, and the difference was statistically significant (P 20% before anesthesia 5 10 23 0.000 Tachycardia Intraoperative HR > 120 bpm 1 2 6 0.085 Low SpO2 Intraoperative SpO2 ≤ 95% 7 3 9 0.477 Cough Intraoperative occurs severe coghing 14 13 23 0.037 Body movement Visible hand bending or head movement 12 16 7 0.032 Operator satisfaction satisfactory/general/unsatisfactory 6/27/1 4/26/0 0/29/4 0.008 Patient satisfaction satisfactory/general/unsatisfactory 3/30/1 5/24/1 0/12/21 0.000 HR:heart rate;SpO2: pulse oximeter oxygen saturation DISCUSSION This clinical study evaluated the safety and feasibility of remimazolam toluesulfate in geriatric patients undergoing painless bronchoscopy by compared with midazolam group and local anesthesia group. Midazolam plus fentanyl is a commonly used sedative and/or analgesic combination in current bronchoscopy practice. These medcines sometimes were adminstered by the endoscopists without invovement of any anesthesiologist. However, serious adverse events such as respiratory depression, apnea, delayed recovery, and cognitive impairment may occur as a result. Based on these risks,endoscopists prefer local anesthesia or general anesthesia with an anesthesiologist. Remimazolam as a new other benzodiazepine has many properties such as rapid onset, short duration, quick recovery,low inmpact of vital signs(include respiration and circulation) different from the traditional benzodiazepines. A single dose-escalation study of healthy volunteers in the United States showed that after intravenous injection of remimazolam tosylate greater than or equal to 0.05mg/kg, a rapid onset and dose-dependent sedative effect can be observed, and the sedation depth of 0.075-0.200mg/kg remimazolam toluenesulfate was similar to or deeper than that of midazolam 0.075 mg/kg, and the median time to recovery of consciousness is shorter (5.5–20.0, 40.0 min, respectively)[ 5 , 6 , 7 ]. Another prospective, randomized, double-blind and multi-center bronchoscopic clinical trial of self-administration of sedation by respiratory physicians found that the effective rates of sedation with remimazolam tosylate, midazolam, and placebo were respectively 80.6%, 32.9%, and 4.8%, and the patients in the remimazolam toluenesulfate group had a faster return to vigilance and a lower incidence of adverse events than those in the placebo group (5.6% vs. 6.8%)[ 8 , 9 ]. Our experiment further confirmed those results. Our clinical single-center Randomized Controlled Trial (RCTS) found that the effects of remimazolam toluesulfate and midazolam on MAP, HR, and RR at various time points in elderly patients undergoing bronchoscopy were significantly lower than those of local anesthesia, and the incidence of hypertension in the remimazolam tosylate and midazolam group was lower than that in the local anesthesia group; in addition,there was no significant difference in SpO 2 and PetCO 2 among the three groups. Also,our study found that the onset time and recovery time of the remimazolam group(2.46 ± 0.83min,0.25 ± 0.73min) were shortened than midazolam group(4.80 ± 1.03min,2.03 ± 2.31min ). Throgh this study we believe that anesthesia induction with remimazolam combined with low-dose fentanyl for sedation under bronchoscopy is safe and feasible as midazolam. It reduces hemodynamic fluctuations, shortens drug onset time and patient recovery time. The EEG bispectral index (BIS) is one of the reliable methods for evaluating the degree of anesthesia and sedation at present. At present, a large number of studies have proved that BIS has a good correlation with intravenous anesthetics. For example, the study of Kerssens et al. [ 10 , 11 , 12 ] showed that when the BIS value was controlled at 40–60 during propofol anesthesia, the sound stimulation method of playing recordings was used and no intraoperative awareness occurred. Therefore, this study used intraoperative BIS monitoring to evaluate the degree of sedation of patients in the remimazolam tosylate group and midazolam group during the FB examination. We analyzed the average range values of MAP, HR, BIS, and RR in the two groups during the examination (i.e., T1-T3), and found that the average range values(highest value-lowest value) of the MAP, HR, BIS, and RR in the remimazolam tosylate group were smaller than the midazolam group, which indicating that the changes in hemodynamics, respiration and BIS in the remimazolam tosylate group were more stable than those in the midazolam group. The MOAA/S score is also a clinical observation index to measure the depth of anesthesia, and its good correlation with different degrees of sedation of patients has been confirmed in related research at home and abroad [ 13 , 14 , 15 ]. The MOAA/S score has been regarded as the clinical observation standard for the change of sedation depth in many studies [ 15 , 16 , 17 ]. In the study of Zhong Tao [ 18 ] et al., BIS and CSI showed a good correlation with MOAA/S scores, and there was no statistical difference between the correlation coefficients of the two indicators,which means that BIS, CSI and MOAA/S can all reflect the changes in the sedation level of patients. Our study showed that the MOAA/S scores of patients in the remimazolam tosylate group and midazolam group at various time points were not statistically significant. But after induction (T1), fiberoptic bronchoscopic entry into the glottis (T2), the MOAA/S score of the remimazolam tosylate group was slightly lower than that of the midazolam group, but there was no statistical difference. This may be due to the rapid onset of ramazolam toluenesulfate, while midazolam has been effective but may not have reached the peak effect. This study has certain limitations. First, this clinical trial is a single center with a small sample size, and the results need to be further verified by multi-center large-sample clinical trials; second, due to limited conditions, we did not use double-blind RCT, which may have certain bias; third, we only evaluated adverse reactions such as hypertension, hypotension, arrhythmia, coughing, body movement, and hypoxemia during the operation, and did not evaluate other adverse reactions such as nausea, vomiting, and headache. These deficiencies need to be improved in the next step of large sample multi-center clinical research. CONCLUSION Under the conditions of this clinical observation, we draw the following conclusions: Anesthesia induction with Remazolam toluenesulfate combined with low-dose fentanyl for sedation, and anesthesia maintenance with repeated dose fentanyl (25µg) every 5 to 10 minutes under bronchoscopy is safe and feasible, and has the advantages of patient satisfaction, rapid induction and recovery, little impact on hemodynamics and spontaneous breathing, and achieve a good anesthesia effect. Declarations Human Ethics and Consent to Participate declarations This study protocol was established according to 1964 Helsinki declaration and its later amendments or comparable ethical.And All procedures performed in the study involving human participants were in accordance with the ethical standards of the Human Ethics Committee of Affiliated Hangzhou First People´s Hospital,School of Medicine,Wsetlake University, and following approval by the Human Ethics Committee of Affiliated Hangzhou First People´s Hospital,School of Medicine,Wsetlake University(2020YLSD003- 01). In this study, we respect and protect the rights and privacy of the participants, and ensure the confidentiality of their personal information. we provided written form to all the participants involved in the research illustrates the research purpose, process, the risks and benefits, and obtained their individual or guardian participants written informed consent. Trail Registration This study was registered with the Chinese clinical trial registry (ChiCTR2100047459),the Registration Date is 2021/06/19. Consent for publication Not applicable. Competing Interest declaration The authors declare that they have no competing interests. Availability of data and materials All data generated or analysed during this study are include in this published article.Some of the raw data are not publicly available and are available from the authors on request. Competing Interests The authors declare that they have no competing interests. Author Contributions Yaqin Huang:conception and design,data analysis.Yang Yu :collection of data and data analysis.Weiping Lei:collection of data. Jianliang Sun:administrative support and randomization and maintaining the group assignment numbers.All authors wrote and approved the manuscript. Funding The project was supported by the National Natural Science Foundation of China (No. 82271445)， the Natural Science Foundation of Zhejiang Province of China (No. LY21H090005), the Construction Fund of Key Medical Disciplines of Hangzhou (Anesthesia and Pain Medicine OO20200484). References Neid Hart G, Kovacs AF, Bremerich DH. Remifentanil-propofol for bronchoscopic fiber optic intubation under capnographic control. Anaesthesiat. 2000;49(6):523–6. Leiten EO, Martinsen EMH, Bakke PS, Eagan TML, Grønseth R. Complications and discomfort of bronchoscopy:a systematic review. Eur Clin Res J. 2016;3(1):324–33. Gavin J. Remimazolam:non-clinical and clinical profile of a new sedative/ anesthetic agent. Front Pharmacol. 2021;12(7):875–93. Sneyd JR, Rigby-Jones AE. Remimazolam for anaesthesia or sedation. Curr Opin Anaesthesiol. 2020;33(4):506–11. Antonik LJ, Goldwater DR, Kilpatrick GJ, Tilbrook GS, Borkett KM. A placebo- and midazolam-controlled phase I single ascending-dose study evaluating the safety, pharmacokinetics, and pharmacodynamics of remimazolam (CNS 7056): Part I. Safety, efficacy, and basic pharmacokinetics. Anesth Analg. 2012;115(2):274–83. Natalini G, Fassini P, Seramondi V, Amicucci G, Toninelli C, Cavaliere S, Candiani A. Remifentanil vs fentanyl during interventional rigid bronchoscopy under general anaesthesia and spontaneous assisted ventilation. Eur J Anaesthesiol. 1999;16(9):605–9. Hill AJ, Feneck RO, Underwood SM, Davis ME, Marsh A, Bromley L. The haemodynamic effects of bronchoscopy. Comparison of propofol and thiopentone with and without alfentanil pretreatment. Anaesthesia. 1991;46(4):266–70. Pastis NJ, Yarmus LB, Schippers F, Ostroff R, Chen A, Akulian J, Wahidi M, Shojaee S, Tanner NT, Callahan SP, Feldman G, Lorch DG Jr, Ndukwu I, Pritchett MA, Silvestri GA. PAION Investigators. 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Performance ofthe ARX-derived auditory evoked potential index as an indicator ofanesthetic depth:A comparison with bispectral index and hemodynamic measures during propofol administration. Anesthesiology. 2002;96(4):803–16. Johansen JW, Sebel PS. Development and clinical application of electroencephalographic bispectrum monitoring. Anesthesiology. 2000;93(5):1336–44. Schmidt GN, Bischoff P, Standl T, Hellstern A, Teuber O, Schulte Esch J. Comparative evaluation of the Datex-Ohmeda S/5 Entropy Module and the Bispectral Index monitor during propofol-remifentanil anesthesia. Anesthesiology. 2004;101:1283–90. Struys MM, Vereecke H, Moerman A, Jensen EW, Verhaeghen D, De Neve N, Dumortier FJ, Mortier EP. Ability of the bispectral index, autoregressive modelling with exogenous input-derived auditory evoked potentials, and predicted propofol concentrations to measure patient responsiveness during anesthesia with propofol and remifentanil. Anesthesiology. 2003;99:802–12. Bruhn J, Bouillon TW, Radulescu L, Hoeft A, Bertaccini E, Shafer SL. Correlation of approximate entropy, bispectral index, and spectral edge frequency 95 (SEF95) with clinical signs of anesthetic depth during coadministration of propofol and remifentanil. Anesthesiology. 2003;98:621–7. Zhong, Tao. Guo Qu-lian, Pan Y-dan. Comparison between anesthesia depth index and bispectrum index of EEG in determining sedation depth of patients undergoing target-controlled infusion of propofol. Chin J Anesthesiology. 2005;25(12):894–7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 13 Oct, 2025 Read the published version in BMC Anesthesiology → Version 1 posted Editorial decision: Revision requested 25 Jun, 2024 Editor assigned by journal 25 Jun, 2024 Submission checks completed at journal 25 Jun, 2024 First submitted to journal 16 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4589360","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":318819512,"identity":"869dbc93-325c-4e35-8d43-5608768fb0b1","order_by":0,"name":"Yaqin Huang","email":"","orcid":"","institution":"Wsetlake University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yaqin","middleName":"","lastName":"Huang","suffix":""},{"id":318819513,"identity":"5da5b1cd-1cc8-453e-bdd6-8e29ea40cbc4","order_by":1,"name":"Yang Yu","email":"","orcid":"","institution":"to Nantong University School","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Yu","suffix":""},{"id":318819514,"identity":"f7f1c538-a7b9-489d-8362-44ef0f13399e","order_by":2,"name":"Weiping Lei","email":"","orcid":"","institution":"Wsetlake University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Weiping","middleName":"","lastName":"Lei","suffix":""},{"id":318819515,"identity":"f66c4466-0d8e-4c3a-9af3-5c257c5772d4","order_by":3,"name":"Jianliang Sun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAt0lEQVRIiWNgGAWjYBACxgYQyWMhx8befoAkLRLGfDxnEkiyTCJxnoSDAXFqmWdkJ3/8ISOR3ibBkMDwo2IbEQ7rObvBmIdHIrdNuvEAY8+Z20Roae/dkMwA0iJzIIGZsY0YLc28Gw7+4JFIZ5NIMCBSS3vvxgagwxJI0NJzdjMzUIthGzCQDxLlF8MZuZs//uyxkZdvbz/44EcFMVoawFZBOAcIqwcCeTD5gyi1o2AUjIJRMFIBANWoOGKT0tkTAAAAAElFTkSuQmCC","orcid":"","institution":"Wsetlake University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Jianliang","middleName":"","lastName":"Sun","suffix":""}],"badges":[],"createdAt":"2024-06-16 10:38:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4589360/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4589360/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12871-025-03349-8","type":"published","date":"2025-10-13T15:58:01+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60637866,"identity":"b1b9f966-10df-4183-b011-d62c6cbe9663","added_by":"auto","created_at":"2024-07-19 02:45:57","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":230516,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4589360/v1/69e4e1df3ed76aa7c740033d.jpeg"},{"id":93957055,"identity":"13962e15-7ef5-42ef-9ec9-2163abd17e40","added_by":"auto","created_at":"2025-10-20 16:12:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":953085,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4589360/v1/40ccbd10-f4bf-4861-b6da-f7a1899269f4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Feasibility and safety evaluation of remimazolam tosylate in geriatric patients during bronchoscopy ： A single-centre randomized controlled trial","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eFiberoptic bronchoscopy (FB, referred to as fiberoptic bronchoscopy) is an important means of diagnosis and treatment of airway diseases, lung infections, malignant tumors, diffuse lung diseases and other respiratory diseases currently. However, as an invasive operation, FB strongly stimulates the airway during the examination which causing great pain to patients and even causing complications such as bleeding, laryngeal spasm, pneumothorax, infection, hypoxemia, arrhythmia, hypertension and cerebrovascular accident \u003csup\u003e[1,2]\u003c/sup\u003e. Therefore, the FB examination process is often forced to pause several times during the routine general tracheal mucosal surface anesthesia, which significantly affects the quality and safety of the FB examination. Therefore, it is urgent to find a safe, effective and comfortable sedation/analgesia or anesthesia method for FB examination.\u003c/p\u003e \u003cp\u003eAt present, general anesthesia and moderate sedation are common used for clinical painless FB diagnosis and treatment. For moderate sedation, propofol,midazolam, remifentanil, fentanyl and dexmedetomidine are often used for mid-depth sedation and analgesia. These drugs depress respiration or circulation to varying degrees,or have long half-life, that restrict theirs using. Patients who undergoing FB are often older or have respiratory system complications, resulting in poor oxygen reserve and oxygenation disorders,etc. Therefore,the moderate sedation medications which is mild respiratory circulation suppression, rapid induction and recovery, and is suitable for elderly patients of relatively insufficient cardiopulmonary function reserve still needs further clinical research.\u003c/p\u003e \u003cp\u003eRemimazolam tosylate is an ester-based benzodiazepine derivative that acts on γ-aminobutyric acid type A (GABAA) receptors and has the pharmacological properties of classic benzodiazepines (such as midazolam). Unlike other benzodiazepines, it can be rapidly hydrolyzed by esterase; compared with other intravenous sedative drugs (such as propofol), its advantages include slight respiratory depression, stable hemodynamics, low incidence of intravenous pain, and there is no accumulation in the body [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Remimazolam tosylate is rapidly metabolized by non-specific esterases in the body and independ on liver and kidney functions. The pharmacokinetics is linear, and the time-dosage-related half-life (CSHT) is not affected by the infusion time. Metabolites have little pharmacological activity and its effects can be rapidly reversed by flumazenil [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Based on the above-mentioned characteristics of remimazolam tosylate, some studies have applied it to painless diagnosis and treatment such as gastrointestinal endoscopy and hysteroscopy. The purpose of this study is to observe and evaluate the safety and feasibility of clinical application of remimazolam tosylate in geriatric patients undergoing fiberoptic bronchoscopy.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003ePatients\u003c/p\u003e \u003cp\u003e The RCT was conducted at the Hangzhou First People\u0026rsquo;s Hospital,School of Medicine,Westlake University,following approval by the Ethics Committee (2020YLSD003- 01) and was registered with the Chinese clinical trial registry (ChiCTR2100047459).A total of 105 elderly patients who underwent bronchofiberoscopy were enrolled in this study and all participants signed the informed consent form. The inclusion criteria were as follows: (1) patients with an American Society of Anesthesiologists (ASA) class I or II (2)Geriatric patients with respiratory diseases undergoing elective FB treatment (routine bronchoscopy and some simple FB treatments including transbronchial needle aspiration biopsy, transbronchial brushing, and bronchoalveolar lavage);(3)age 60\u0026thinsp;~\u0026thinsp;80 years old;(4)body mass index\u0026thinsp;\u0026lt;\u0026thinsp;30kg/m2. The exclusion criteria were as follows: (1) operation time\u0026thinsp;\u0026gt;\u0026thinsp;30min;(2)patients with neuropsychiatric diseases and taking related drugs;(3) patients with target organ damage such as liver, kidney, heart and brain; (4)patients with allergies to anesthetic drugs;(5) those who cannot cooperate with doctors;(6) Patients with or uncontrolled hypertension, heart disease, diabetes and other diseases.\u003c/p\u003e \u003cp\u003eGrouping\u003c/p\u003e \u003cp\u003eThe patients were randomly assigned to three groups (n\u0026thinsp;=\u0026thinsp;35 each) using a list of numbers generated by the QuickCalcs (GraphpadPrism 7):Group A (remimazolam tosylate group): intravenous injection of remazolam 0.2 mg/kg and fentanyl 0.5 \u0026micro;g/kg for sedation; Group B (midazolam group): intravenous injection of midazolam 0.075mg/kg and fentanyl 0.5 \u0026micro;g/kg for sedation ; and an additional dose with fentanyl 25 \u0026micro;g every 5 to 10 minutes for the either group if necessary; Group C (control group): routine tracheal mucosal. The group assignment numbers were sealed in an envelope, and opened once written informed consent was obtained.As illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eExperimental Protocols\u003c/p\u003e \u003cp\u003eThe patients were instructed to fast before the operation. Electrocardiogram\u003c/p\u003e \u003cp\u003e(ECG), heart rate (HR), non-invasive blood pressure (BP), saturation of pulse oximetry (SpO\u003csub\u003e2\u003c/sub\u003e), end-tidal carbon dioxide (PetCO\u003csub\u003e2\u003c/sub\u003e) and bispectral index (BIS) were monitered in the operating room with the patient in supine position. Group A was inducted by intravenous injection of remimazolam tosylate 0.2mg/kg and fentanyl 0.5\u0026micro;g/kg for sedation/analgesia. Group B was inducted by intravenous injection of midazolam 0.075mg/kg and fentanyl 0.5\u0026micro;g/kg for sedation/analgesia. Group C was performed by spraying 2% lidocaine on the surface of tracheal mucosa without any other special treatment.\u003c/p\u003e \u003cp\u003eThe endoscopic operation process was completed by an experienced respiratory physician. Each patient was assisted with local anesthesia with 2% lidocaine mucosal surface spraying when the fiberoptic bronchoscope first entered the glottis, carina, and left and right bronchus, and then fiberoptic bronchoscopy was performed.\u003c/p\u003e \u003cp\u003eWhen the Modified Observer\u0026rsquo;s Alertness/Sedation (MOAA/S) score was \u0026le;\u0026thinsp;3, bronchoscopy was started. If persistent coughing occurs during the operation and body movement affects the operation of the operator, 25 \u0026micro;g of fentanyl can be added every 5 to 10 minutes until achived a maximum of 200 \u0026micro;g. It was designated a treatment failure if the dgree of sedation still insufficient to operation. Every patient was sent to the post-anesthesia care unit (PACU) after operation. Patients can exit PACU untill regained consciousness and completed command actions, recover orientation ability, and raise the head while supine for more than 10 seconds. HR, BP, MAP, SpO2, PetCO2, BIS were recorded when the patient was awake while breathing room air before anesthesia (T0), the post-anesthesia induction state (T1) under nasal cannula oxygen inhalation (oxygen flow rate 3-5L/min), the time when the bronchoscope was inserted into the glottis (T2), the postoperative at the time of completion (T3) and when the patient wakes up (T4).\u003c/p\u003e \u003cp\u003eRecord the onset time of the drug, operation time (the time from the beginning of insertion of the bronchoscope to the completion of the insertion), and recovery time (have command action, recovery of orientation ability, time to raise the head in supine position\u0026thinsp;\u0026gt;\u0026thinsp;10s).Intraoperative coughing, hypoxemia, and other adverse events (including blood pressure fluctuation\u0026thinsp;\u0026gt;\u0026thinsp;20% before anesthesia, heart rate\u0026thinsp;\u0026lt;\u0026thinsp;50 beats/min or \u0026gt;\u0026thinsp;120 beats/min, arrhythmia, larynx or bronchospasm, etc.) were recorded. Assessment of surgeon satisfaction (excellent: the opening of the glottis is excellent; good: the opening of the glottis is good, the mirror placement is smooth, and the patient's cooperation is good; poor: the opening of the glottis is not good, there is obvious body movement or coughing, which leads to mirror withdrawal affecting the operator's operation),patient's satisfaction (satisfactory/general/unsatisfactory). Record the MOAA/S scores of groups A and B at each time point from T0 to T4: 5 points - Responds readily to name spoken in normal tone; 4 points - Lethargic response to name spoken in normal tone; 3 points - Responds only after name is called loudly and/or repeatedly; 2 points - Responds only after mild prodding or shaking; 1 point - Responds only after painful trapezius squeeze; 0 point - Does not respond to painful trapezius squeeze.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe sample size for calculating the difference in recovery time between the two groups was determined using G-power (version 3.1.9.2, α\u0026thinsp;=\u0026thinsp;0.05, power\u0026thinsp;=\u0026thinsp;0.8) depending on our preliminary study results (intervention group: mean\u0026thinsp;=\u0026thinsp;2.26, SD\u0026thinsp;=\u0026thinsp;2.08; control group: mean\u0026thinsp;=\u0026thinsp;4.25, SD\u0026thinsp;=\u0026thinsp;3). A total of 28 patients were required per group, and considering an expulsion rate of 0.2, the sample size was increased to 35 patients per group.\u003c/p\u003e \u003cp\u003eAll variables were expressed as numbers, mean (SD) or median (interquartile range). Statistical analysis was performed using the SPSS25.0 Software and the measurement data was normally distributed using the Shapiro-Wilk test. The normally distributed measurement data were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (X\u0026thinsp;\u0026plusmn;\u0026thinsp;s), and the comparison between groups was analyzed by one-way ANOVA, and the Bonferroni multiple comparison test was performed, and the Welch test was used for heterogeneity of variance. Non-normally distributed continuous variables were expressed as medians (interquartile ranges), and analyzed using nonparametric tests (Kruskal-Wallis H test). Counting data were compared using chi-square test or Fisher test, and Bonferroni correction test was used. Bilateral P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eAccording to the inclusion and exclusion criteria, a total of 105 patients were enrolled in this study. Among them, the data of 3 cases were missing, 4 patients refused to enter the group, and 1 case changed the anesthesia method, so they were excluded from the study. Finally, the data of 97 patients were analyzed statistically (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).The general data of the three groups of patients are showed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. There were no significant differences in age, sex, ASA classification, weight, height, and BMI among the three groups (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).Compared with group C, the operation time in group B was significantly shortened, and the difference was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).Compared with group B, the onset time and recovery time of group A were shortened (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was no statistical significance in the number of additional drugs in group A and B.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics and clinical data of three group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup A\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup B\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup C\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(years)\u003c/p\u003e \u003cp\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.65\u0026thinsp;\u0026plusmn;\u0026thinsp;13.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.37\u0026thinsp;\u0026plusmn;\u0026thinsp;12.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.00\u0026thinsp;\u0026plusmn;\u0026thinsp;13.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.658\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender,n(%)\u003c/p\u003e \u003cp\u003e(male/female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22/12(64.7/35.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18/12(60/40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24/9(72.7/27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.565\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA PS,n(%)\u003c/p\u003e \u003cp\u003e(Ⅰ/Ⅱ)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7/27(20.6/79.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/27(10/90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7/26(21/79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.434\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight(kg)\u003c/p\u003e \u003cp\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.60\u0026thinsp;\u0026plusmn;\u0026thinsp;12.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.18\u0026thinsp;\u0026plusmn;\u0026thinsp;12.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.89\u0026thinsp;\u0026plusmn;\u0026thinsp;8.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.906\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight(cm)\u003c/p\u003e \u003cp\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e165.91\u0026thinsp;\u0026plusmn;\u0026thinsp;7.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163.27\u0026thinsp;\u0026plusmn;\u0026thinsp;7.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e163.00\u0026thinsp;\u0026plusmn;\u0026thinsp;6.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI(kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003cp\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.26\u0026thinsp;\u0026plusmn;\u0026thinsp;3.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.20\u0026thinsp;\u0026plusmn;\u0026thinsp;3.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.95\u0026thinsp;\u0026plusmn;\u0026thinsp;3.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.543\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnset time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation time\u003c/p\u003e \u003cp\u003e(min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.79\u0026thinsp;\u0026plusmn;\u0026thinsp;9.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.57\u0026thinsp;\u0026plusmn;\u0026thinsp;7.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.00\u0026thinsp;\u0026plusmn;\u0026thinsp;11.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecovery time\u003c/p\u003e \u003cp\u003e(min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe number of additional drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.275\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eASA PS: the American Society of Anesthesiologists physical status;BMI: body mass index.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe comparison of the vital signs of the three groups at different time points is shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.There was no significant difference in the mean arterial pressure of the three groups after entering the room and breathing room air before anesthesia. Compared with group C, MAP in group A decreased significantly at each time point of T1, T2, T3, and T4 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and the difference was statistically significant. Compared with group B, MAP in group A decreased significantly at T1 and T2 time points. Compared with group C, MAP in group B decreased significantly at T3 and T4 time points. Compared with group C, HR in group A decreased significantly at T3 and T4 time points. There was no significant difference in SpO2 and PetCO2 at T0, T1, T2, T3, and T4 time points among the three groups of patients. There was no significant difference in BIS between the two groups at T0, T1, T2, T3, and T4 time points. Compared with group C, the RR in group A was significantly lower at each time point of T2, T3 and T4. Compared with group C, the RR in group B was significantly lower at each time point of T2, T3, and T4. The average range values ​(highest value-lowest value) of MAP, HR, BIS, and RR in group A were smaller than those in group B showed in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. There was no statistical significance in the MOAA/S scores of the two groups at each time point from T0 to T4(Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe vital signs of the three groups at different time points\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT0\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eT4\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eMAP(mmHg)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81.05\u0026thinsp;\u0026plusmn;\u0026thinsp;11.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.17\u0026thinsp;\u0026plusmn;\u0026thinsp;12.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71.84\u0026thinsp;\u0026plusmn;\u0026thinsp;9.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e77.23\u0026thinsp;\u0026plusmn;\u0026thinsp;11.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e76.43\u0026thinsp;\u0026plusmn;\u0026thinsp;12.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78.72\u0026thinsp;\u0026plusmn;\u0026thinsp;15.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.62\u0026thinsp;\u0026plusmn;\u0026thinsp;14.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84.07\u0026thinsp;\u0026plusmn;\u0026thinsp;19.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e82.86\u0026thinsp;\u0026plusmn;\u0026thinsp;17.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e81.53\u0026thinsp;\u0026plusmn;\u0026thinsp;13.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC (n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83.34\u0026thinsp;\u0026plusmn;\u0026thinsp;16.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.34\u0026thinsp;\u0026plusmn;\u0026thinsp;16.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90.34\u0026thinsp;\u0026plusmn;\u0026thinsp;23.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e92.77\u0026thinsp;\u0026plusmn;\u0026thinsp;17.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e92.77\u0026thinsp;\u0026plusmn;\u0026thinsp;17.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.465\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eHR(bpm)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80.65\u0026thinsp;\u0026plusmn;\u0026thinsp;10.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.68\u0026thinsp;\u0026plusmn;\u0026thinsp;11.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87.06\u0026thinsp;\u0026plusmn;\u0026thinsp;12.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88.03\u0026thinsp;\u0026plusmn;\u0026thinsp;12.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e85.29\u0026thinsp;\u0026plusmn;\u0026thinsp;10.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81.53\u0026thinsp;\u0026plusmn;\u0026thinsp;16.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93.00\u0026thinsp;\u0026plusmn;\u0026thinsp;16.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.03\u0026thinsp;\u0026plusmn;\u0026thinsp;17.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.07\u0026thinsp;\u0026plusmn;\u0026thinsp;18.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e94.00\u0026thinsp;\u0026plusmn;\u0026thinsp;18.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC (n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84.45\u0026thinsp;\u0026plusmn;\u0026thinsp;17.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.45\u0026thinsp;\u0026plusmn;\u0026thinsp;17.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94.42\u0026thinsp;\u0026plusmn;\u0026thinsp;18.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.21\u0026thinsp;\u0026plusmn;\u0026thinsp;17.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100.21\u0026thinsp;\u0026plusmn;\u0026thinsp;17.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.558\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eSpO\u003csub\u003e2\u003c/sub\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99.06\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.26\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98.35\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98.29\u0026thinsp;\u0026plusmn;\u0026thinsp;2.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e98.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98.47\u0026thinsp;\u0026plusmn;\u0026thinsp;1.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e98.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e98.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC (n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e97.55\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e97.55\u0026thinsp;\u0026plusmn;\u0026thinsp;2.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.532\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.903\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.849\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eBIS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95.35\u0026thinsp;\u0026plusmn;\u0026thinsp;2.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.35\u0026thinsp;\u0026plusmn;\u0026thinsp;13.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.71\u0026thinsp;\u0026plusmn;\u0026thinsp;11.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87.56\u0026thinsp;\u0026plusmn;\u0026thinsp;5.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e91.62\u0026thinsp;\u0026plusmn;\u0026thinsp;5.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93.60\u0026thinsp;\u0026plusmn;\u0026thinsp;3.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.67\u0026thinsp;\u0026plusmn;\u0026thinsp;10.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71.13\u0026thinsp;\u0026plusmn;\u0026thinsp;12.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e86.57\u0026thinsp;\u0026plusmn;\u0026thinsp;7.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e91.57\u0026thinsp;\u0026plusmn;\u0026thinsp;3.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.558\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.898\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.347\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003ePetCO\u003csub\u003e2\u003c/sub\u003e(mmHg)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.44\u0026thinsp;\u0026plusmn;\u0026thinsp;2.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.56\u0026thinsp;\u0026plusmn;\u0026thinsp;1.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38.18\u0026thinsp;\u0026plusmn;\u0026thinsp;2.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37.56\u0026thinsp;\u0026plusmn;\u0026thinsp;3.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38.47\u0026thinsp;\u0026plusmn;\u0026thinsp;3.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.97\u0026thinsp;\u0026plusmn;\u0026thinsp;2.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e36.90\u0026thinsp;\u0026plusmn;\u0026thinsp;2.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e38.43\u0026thinsp;\u0026plusmn;\u0026thinsp;2.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC (n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.85\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.85\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37.79\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37.79\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.742\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.527\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.731\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.550\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.248\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eRR(bpm)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.21\u0026thinsp;\u0026plusmn;\u0026thinsp;3.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.32\u0026thinsp;\u0026plusmn;\u0026thinsp;2.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.91\u0026thinsp;\u0026plusmn;\u0026thinsp;2.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.44\u0026thinsp;\u0026plusmn;\u0026thinsp;2.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17.59\u0026thinsp;\u0026plusmn;\u0026thinsp;3.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.63\u0026thinsp;\u0026plusmn;\u0026thinsp;2.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.80\u0026thinsp;\u0026plusmn;\u0026thinsp;2.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.73\u0026thinsp;\u0026plusmn;\u0026thinsp;2.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17.53\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC (n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.712\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eT0: before anesthesia; T1:the post-anesthesia induction state;T2:the time when the bronchoscope was inserted into the glottis;T3:the postoperative at the time of completion;T4:when the patient wakes up. MAP:mean blood pressure;HR:heart rate;BIS:bispectral index;SpO2: pulse oximeter oxygen saturation;PetCO\u003csub\u003e2\u003c/sub\u003e:End-tidal carbon dioxide partial pressure;RR:respiratory rate.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the mean range values\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMAP(mmHg)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHR(bpm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBIS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRR(bpm)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eThe average range values(highest value-lowest value) of MAP, HR, BIS, and RR\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMOAA/S at each time point among the three groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eMOAA/S\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT0\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eT3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eT4\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA (n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.88\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.00\u0026thinsp;\u0026plusmn;\u0026thinsp;0.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.525\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.914\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.825\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eMOAA/S :Modified Observer\u0026rsquo;s Assessment of Alertness/Sedation Scale.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe comparison of adverse events, operator satisfaction and patient satisfaction among the three groups are shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. There was no significant difference in tachycardia, arrhythmia, hypoxemia among the three groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The incidence of hypertension and coughing in group A and group B was significantly lower than that in group C, but body movement increased compared with group C, and the difference was statistically significant (both P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The patient satisfaction and operator satisfaction in groups A and B were higher than those in group C, and the difference was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAdverse event and satisfaction statistics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdverse events\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDefinitions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup A\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;34)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGroup B\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGroup C\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;33)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eblood pressure fluctuation\u0026thinsp;\u0026gt;\u0026thinsp;20% before anesthesia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTachycardia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntraoperative HR\u0026thinsp;\u0026gt;\u0026thinsp;120 bpm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow SpO2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntraoperative SpO2\u0026thinsp;\u0026le;\u0026thinsp;95%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.477\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCough\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntraoperative occurs severe coghing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody movement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVisible hand bending or head movement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperator satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esatisfactory/general/unsatisfactory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6/27/1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/26/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0/29/4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esatisfactory/general/unsatisfactory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/30/1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5/24/1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0/12/21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eHR:heart rate;SpO2: pulse oximeter oxygen saturation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis clinical study evaluated the safety and feasibility of remimazolam toluesulfate in geriatric patients undergoing painless bronchoscopy by compared with midazolam group and local anesthesia group. Midazolam plus fentanyl is a commonly used sedative and/or analgesic combination in current bronchoscopy practice. These medcines sometimes were adminstered by the endoscopists without invovement of any anesthesiologist. However, serious adverse events such as respiratory depression, apnea, delayed recovery, and cognitive impairment may occur as a result. Based on these risks,endoscopists prefer local anesthesia or general anesthesia with an anesthesiologist. Remimazolam as a new other benzodiazepine has many properties\u003c/p\u003e \u003cp\u003esuch as rapid onset, short duration, quick recovery,low inmpact of vital signs(include respiration and circulation) different from the traditional benzodiazepines.\u003c/p\u003e \u003cp\u003eA single dose-escalation study of healthy volunteers in the United States showed that after intravenous injection of remimazolam tosylate greater than or equal to 0.05mg/kg, a rapid onset and dose-dependent sedative effect can be observed, and the sedation depth of 0.075-0.200mg/kg remimazolam toluenesulfate was similar to or deeper than that of midazolam 0.075 mg/kg, and the median time to recovery of consciousness is shorter (5.5\u0026ndash;20.0, 40.0 min, respectively)[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Another prospective, randomized, double-blind and multi-center bronchoscopic clinical trial of self-administration of sedation by respiratory physicians found that the effective rates of sedation with remimazolam tosylate, midazolam, and placebo were respectively 80.6%, 32.9%, and 4.8%, and the patients in the remimazolam toluenesulfate group had a faster return to vigilance and a lower incidence of adverse events than those in the placebo group (5.6% vs. 6.8%)[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Our experiment further confirmed those results.\u003c/p\u003e \u003cp\u003eOur clinical single-center Randomized Controlled Trial (RCTS) found that the effects of remimazolam toluesulfate and midazolam on MAP, HR, and RR at various time points in elderly patients undergoing bronchoscopy were significantly lower than those of local anesthesia, and the incidence of hypertension in the remimazolam tosylate and midazolam group was lower than that in the local anesthesia group; in addition,there was no significant difference in SpO\u003csub\u003e2\u003c/sub\u003e and PetCO\u003csub\u003e2\u003c/sub\u003e among the three groups. Also,our study found that the onset time and recovery time of the remimazolam group(2.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.83min,0.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73min) were shortened than midazolam group(4.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03min,2.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.31min ). Throgh this study we believe that anesthesia induction with remimazolam combined with low-dose fentanyl for sedation under bronchoscopy is safe and feasible as midazolam. It reduces hemodynamic fluctuations, shortens drug onset time and patient recovery time.\u003c/p\u003e \u003cp\u003eThe EEG bispectral index (BIS) is one of the reliable methods for evaluating the degree of anesthesia and sedation at present. At present, a large number of studies have proved that BIS has a good correlation with intravenous anesthetics. For example, the study of Kerssens et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] showed that when the BIS value was controlled at 40\u0026ndash;60 during propofol anesthesia, the sound stimulation method of playing recordings was used and no intraoperative awareness occurred. Therefore, this study used intraoperative BIS monitoring to evaluate the degree of sedation of patients in the remimazolam tosylate group and midazolam group during the FB examination. We analyzed the average range values of MAP, HR, BIS, and RR in the two groups during the examination (i.e., T1-T3), and found that the average range values(highest value-lowest value) of the MAP, HR, BIS, and RR in the remimazolam tosylate group were smaller than the midazolam group, which indicating that the changes in hemodynamics, respiration and BIS in the remimazolam tosylate group were more stable than those in the midazolam group.\u003c/p\u003e \u003cp\u003eThe MOAA/S score is also a clinical observation index to measure the depth of anesthesia, and its good correlation with different degrees of sedation of patients has been confirmed in related research at home and abroad [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The MOAA/S score has been regarded as the clinical observation standard for the change of sedation depth in many studies [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In the study of Zhong Tao [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] et al., BIS and CSI showed a good correlation with MOAA/S scores, and there was no statistical difference between the correlation coefficients of the two indicators,which means that BIS, CSI and MOAA/S can all reflect the changes in the sedation level of patients. Our study showed that the MOAA/S scores of patients in the remimazolam tosylate group and midazolam group at various time points were not statistically significant. But after induction (T1), fiberoptic bronchoscopic entry into the glottis (T2), the MOAA/S score of the remimazolam tosylate group was slightly lower than that of the midazolam group, but there was no statistical difference. This may be due to the rapid onset of ramazolam toluenesulfate, while midazolam has been effective but may not have reached the peak effect.\u003c/p\u003e \u003cp\u003eThis study has certain limitations. First, this clinical trial is a single center with a small sample size, and the results need to be further verified by multi-center large-sample clinical trials; second, due to limited conditions, we did not use double-blind RCT, which may have certain bias; third, we only evaluated adverse reactions such as hypertension, hypotension, arrhythmia, coughing, body movement, and hypoxemia during the operation, and did not evaluate other adverse reactions such as nausea, vomiting, and headache. These deficiencies need to be improved in the next step of large sample multi-center clinical research.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eUnder the conditions of this clinical observation, we draw the following conclusions: Anesthesia induction with Remazolam toluenesulfate combined with low-dose fentanyl for sedation, and anesthesia maintenance with repeated dose fentanyl (25\u0026micro;g) every 5 to 10 minutes under bronchoscopy is safe and feasible, and has the advantages of patient satisfaction, rapid induction and recovery, little impact on hemodynamics and spontaneous breathing, and achieve a good anesthesia effect.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study protocol was established according to 1964 Helsinki declaration and its later amendments or comparable ethical.And All procedures performed in the study involving human participants were in accordance with the ethical standards of the\u0026nbsp;Human\u0026nbsp;Ethics Committee\u0026nbsp;of\u0026nbsp;Affiliated Hangzhou First People\u0026acute;s Hospital,School of Medicine,Wsetlake University, and\u0026nbsp;following approval by the\u0026nbsp;Human\u0026nbsp;Ethics Committee\u0026nbsp;of\u0026nbsp;Affiliated Hangzhou First People\u0026acute;s Hospital,School of Medicine,Wsetlake University(2020YLSD003- 01).\u003c/p\u003e\n\u003cp\u003eIn this study, we respect and protect the rights and privacy of the participants, and ensure the confidentiality of their personal information. we provided written form to all the participants involved in the research illustrates the research purpose, process, the risks and benefits, and obtained their individual or guardian participants written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrail Registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study\u0026nbsp;was registered with the Chinese clinical trial registry\u003c/p\u003e\n\u003cp\u003e(ChiCTR2100047459),the Registration Date is\u0026nbsp;2021/06/19.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interest declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are include in this published article.Some of the raw data are not publicly available and are available from the authors on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYaqin Huang:conception and design,data analysis.Yang Yu :collection of data and data analysis.Weiping Lei:collection of data. Jianliang Sun:administrative support and randomization and maintaining the group assignment numbers.All authors wrote and approved the manuscript.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe project was supported by the National Natural Science Foundation of China (No. 82271445)， the Natural Science Foundation of Zhejiang Province of China (No. LY21H090005), the Construction Fund of Key Medical Disciplines of Hangzhou (Anesthesia and Pain Medicine OO20200484).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNeid Hart G, Kovacs AF, Bremerich DH. Remifentanil-propofol for bronchoscopic fiber optic intubation under capnographic control. Anaesthesiat. 2000;49(6):523\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeiten EO, Martinsen EMH, Bakke PS, Eagan TML, Gr\u0026oslash;nseth R. Complications and discomfort of bronchoscopy:a systematic review. Eur Clin Res J. 2016;3(1):324\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGavin J. Remimazolam:non-clinical and clinical profile of a new sedative/ anesthetic agent. Front Pharmacol. 2021;12(7):875\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSneyd JR, Rigby-Jones AE. Remimazolam for anaesthesia or sedation. Curr Opin Anaesthesiol. 2020;33(4):506\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAntonik LJ, Goldwater DR, Kilpatrick GJ, Tilbrook GS, Borkett KM. A placebo- and midazolam-controlled phase I single ascending-dose study evaluating the safety, pharmacokinetics, and pharmacodynamics of remimazolam (CNS 7056): Part I. Safety, efficacy, and basic pharmacokinetics. Anesth Analg. 2012;115(2):274\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNatalini G, Fassini P, Seramondi V, Amicucci G, Toninelli C, Cavaliere S, Candiani A. Remifentanil vs fentanyl during interventional rigid bronchoscopy under general anaesthesia and spontaneous assisted ventilation. Eur J Anaesthesiol. 1999;16(9):605\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHill AJ, Feneck RO, Underwood SM, Davis ME, Marsh A, Bromley L. The haemodynamic effects of bronchoscopy. Comparison of propofol and thiopentone with and without alfentanil pretreatment. Anaesthesia. 1991;46(4):266\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePastis NJ, Yarmus LB, Schippers F, Ostroff R, Chen A, Akulian J, Wahidi M, Shojaee S, Tanner NT, Callahan SP, Feldman G, Lorch DG Jr, Ndukwu I, Pritchett MA, Silvestri GA. PAION Investigators. Safety and efficacy of remimazolam compared with placebo and midazolam for moderate sedation during bronchoscopy. Chest. 2019;155(1):137\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePapagiannis A, Smith AP. Fentanyl versus midazolam as premedication for fibre optic bronchoscopy. Respir Med. 1994;88(10):797\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKerssens C, Klein J, van der Woerd A. Bonke B. Auditory information processing during adequate propofol anesthesia monitored by electroencephalogram bispectral index. Anesth Analg. 2001;92(5):1210\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBorkett KM, Riff DS, Schwartz HII, Winkle PJ, Pambianco DJ, Lees JP, Wilhelm-Ogunbiyi K. A Phase IIa, randomized, double-blind study of remimazolam (CNS 7056) versus midazolam for sedation in upper gastrointestinal endoscopy. Anesth Analg. 2015;120(4):771\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDouglas KR, Raj B, Daniel GL, Michael M, Frank S, David B. Safety and efficacy of remimazol-am in high risk colonoscopy:A randomized trial. Dig Liver Dis. 2021;53(1):94\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStruys MM, Jensen EW, Smith W, Smith NT, Rampil I, Dumortier FJ, Mestach C, Mortier EP. Performance ofthe ARX-derived auditory evoked potential index as an indicator ofanesthetic depth:A comparison with bispectral index and hemodynamic measures during propofol administration. Anesthesiology. 2002;96(4):803\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohansen JW, Sebel PS. Development and clinical application of electroencephalographic bispectrum monitoring. Anesthesiology. 2000;93(5):1336\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchmidt GN, Bischoff P, Standl T, Hellstern A, Teuber O, Schulte Esch J. Comparative evaluation of the Datex-Ohmeda S/5 Entropy Module and the Bispectral Index monitor during propofol-remifentanil anesthesia. Anesthesiology. 2004;101:1283\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStruys MM, Vereecke H, Moerman A, Jensen EW, Verhaeghen D, De Neve N, Dumortier FJ, Mortier EP. Ability of the bispectral index, autoregressive modelling with exogenous input-derived auditory evoked potentials, and predicted propofol concentrations to measure patient responsiveness during anesthesia with propofol and remifentanil. Anesthesiology. 2003;99:802\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBruhn J, Bouillon TW, Radulescu L, Hoeft A, Bertaccini E, Shafer SL. Correlation of approximate entropy, bispectral index, and spectral edge frequency 95 (SEF95) with clinical signs of anesthetic depth during coadministration of propofol and remifentanil. Anesthesiology. 2003;98:621\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhong, Tao. Guo Qu-lian, Pan Y-dan. Comparison between anesthesia depth index and bispectrum index of EEG in determining sedation depth of patients undergoing target-controlled infusion of propofol. Chin J Anesthesiology. 2005;25(12):894\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"bronchoscopy, remimazolam tosylate, geriatric patients, anesthesia management","lastPublishedDoi":"10.21203/rs.3.rs-4589360/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4589360/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eFiberoptic 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 evaluate the feasibility and safety of remimazolam tosylate in geriatric patients undergoing fiberoptic bronchoscopy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003e\u0026nbsp;This study is a single-center randomized controlled trial. A total of 105 geriatric patients undergoing fiberoptic bronchoscopy were divided into 3 groups (n=35) randomly. Group A (remimazolam group); Group B (midazolam group); in Group C (control group). Record the all patients’ vital signs and the rate of adverse events.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e A total of 105 patients were enrolled and 97 actual patients (34 patients in group A, 30 patients in group B, and 33 patients in group C) were analyzed in the end. Compared with group C, the vital sign in group A and B are more stable at T1, T2, T3, and T4 (P\u0026lt;0.05).The frequency of hypertension in group A and group B was significantly lower than that in group C(P\u0026lt;0.05). Compared with group B, the onset time and recovery time of group A were shortened (both P\u0026lt;0.05). The satisfaction of patients and operators in group A and group B was higher than that in group C (P\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions \u003c/strong\u003eIn the sduty we found that intravenous injection of remazolam tosylate 0.2 mg/kg, fentanyl 0.5 μg/kg for sedation, and additional anesthesia with fentanyl 25 μg every 5 to 10 minutes if necessary is effictive and safe for geriatricpatients during fiberoptic bronchoscopy .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration:\u003c/strong\u003eThis study was registered with the Chinese clinical trial registry (ChiCTR2100047459),the Registration Date is 2021/06/19.\u003c/p\u003e","manuscriptTitle":"Feasibility and safety evaluation of remimazolam tosylate in geriatric patients during bronchoscopy ： A single-centre randomized controlled trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-19 02:45:52","doi":"10.21203/rs.3.rs-4589360/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-25T12:02:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-25T06:42:49+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-25T06:41:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Anesthesiology","date":"2024-06-16T10:35:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3c052458-63c8-4a33-a727-9ace1475da17","owner":[],"postedDate":"July 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-20T16:11:19+00:00","versionOfRecord":{"articleIdentity":"rs-4589360","link":"https://doi.org/10.1186/s12871-025-03349-8","journal":{"identity":"bmc-anesthesiology","isVorOnly":false,"title":"BMC Anesthesiology"},"publishedOn":"2025-10-13 15:58:01","publishedOnDateReadable":"October 13th, 2025"},"versionCreatedAt":"2024-07-19 02:45:52","video":"","vorDoi":"10.1186/s12871-025-03349-8","vorDoiUrl":"https://doi.org/10.1186/s12871-025-03349-8","workflowStages":[]},"version":"v1","identity":"rs-4589360","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4589360","identity":"rs-4589360","version":["v1"]},"buildId":"ehx78VzkSd0WSzXnipQa-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}