Potential Utility of Endoscopic Ultrasonography Under Sedation with Remimazolam Plus Pethidine Hydrochloride

Endoscopic ultrasonography (EUS) requires sedation due to its strong discomfort. In recent years, the effectiveness of sedation using remimazolam as well as pethidine hydrochloride has been reported. However, the utility of sedation with remimazolam plus pethidine hydrochloride for EUS has not been determined. A total of 325 consecutive outpatient EUS cases performed between January and August 2025 were retrospectively reviewed. Statistical comparisons were performed using Fisher's exact test or the Mann–Whitney U test. Analyses were conducted using BellCurve for Excel, Version 4.08 (Social Survey Research Information Co., Ltd., Tokyo, Japan). A p-value <0.05 was considered statistically significant. Men accounted for 52.9% of the cohort, the median age was 71 years, and 67.1% had American Society of Anesthesiologists physical status of I. Pethidine hydrochloride (35 mg) was administered in all cases. The median initial dose of remimazolam was 2 mg (1–3 mg), and the median dose required until scope insertion was 3 mg (1–7 mg). The median EUS procedure time was 12 minutes. The median total remimazolam dose until EUS completion was 4 mg (1–15 mg). The procedure completion rate without rescue sedation was 96.6%. The median time from EUS procedure completion to patient exit from the endoscopy room was 44 minutes. There were 25 cases (7.7%) of sedation-related adverse events (AEs), with cardiorespiratory AEs occurring in 3.7% of cases. Outpatient EUS under sedation with remimazolam and pethidine hydrochloride achieved a high procedure completion rate and few cardiorespiratory AEs.