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Background <p>The objective of this study was to compare the efficacy and safety of remimazolam and dexmedetomidine in elderly patients undergoing dental implant surgery.</p> Methods <p>Seventy-four elderly patients aged 65–80 years and scheduled for dental implant surgery were randomly divided into two groups. Patients in Group R received a 0.05&#xa0;mg/kg loading dose of remimazolam over 1&#xa0;min and followed by an infusion rate 0.1–0.3&#xa0;mg/kg/h. In Group D, a 0.5&#xa0;µg/kg bolus of dexmedetomidine was given over 10&#xa0;min and followed by an infusion rate 0.2–1.0&#xa0;µg/kg/h. The primary outcome of the study was the incidence of hypotension between the two groups. Secondary outcomes were perioperative complications, hemodynamic and respiratory variables, sedation and recovery profiles.</p> Results <p>The incidence of hypotension in Group R was significantly lower than that in Group D (5.4% vs. 24.3%, RR: 0.22, 95% CI: 0.05–0.96, <i>P</i> = 0.022). The difference of bradycardia was not significant between Group R and Group D (2.6% vs. 13.5%, RR: 0.20, 95% CI: 0.02–1.63, <i>P</i> = 0.088). Only one patient in Group D experienced transient hypoxemia lasting less than 10&#xa0;s. The onset of sedation was much faster in Group R than Group D (105 ± 21&#xa0;s vs. 599 ± 172&#xa0;s, <i>P</i> &lt; 0.01). Two patients in Group D did not reach the target sedative level in 15&#xa0;min after sedative infusion. All patients reached a MOAA/S score of 5 upon completion of the dental implant surgery. However, patients in Group D had a higher incidence of delayed discharge than those in Group R (16.2% vs. 2.7%, <i>P</i> = 0.047).</p> Conclusions <p>Both remimazolam and dexmedetomidine can provide satisfactory sedation with minimal inhibition on respiratory function in elderly patients undergoing dental implant surgery. However, remimazolam is superior to dexmedetomidine, offering better hemodynamic stability, faster onset of sedation, and quicker recovery.</p> Trial registration <p>This study was registered at the Chinese Clinical Trials Registry (Registration ID: ChiCTR2400083062; Registration date: April 15, 2024).</p>

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Comparison of remimazolam and dexmedetomidine for conscious sedation in elderly patients undergoing dental implant surgery: a prospective randomized controlled trial

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  • 发表日期：

    2025年11月17日

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  • Pengfei Gao,
  • Jing Wang,
  • Yang Ji,
  • Qiang Luo

摘要

Background

The objective of this study was to compare the efficacy and safety of remimazolam and dexmedetomidine in elderly patients undergoing dental implant surgery.

Methods

Seventy-four elderly patients aged 65–80 years and scheduled for dental implant surgery were randomly divided into two groups. Patients in Group R received a 0.05 mg/kg loading dose of remimazolam over 1 min and followed by an infusion rate 0.1–0.3 mg/kg/h. In Group D, a 0.5 µg/kg bolus of dexmedetomidine was given over 10 min and followed by an infusion rate 0.2–1.0 µg/kg/h. The primary outcome of the study was the incidence of hypotension between the two groups. Secondary outcomes were perioperative complications, hemodynamic and respiratory variables, sedation and recovery profiles.

Results

The incidence of hypotension in Group R was significantly lower than that in Group D (5.4% vs. 24.3%, RR: 0.22, 95% CI: 0.05–0.96, P = 0.022). The difference of bradycardia was not significant between Group R and Group D (2.6% vs. 13.5%, RR: 0.20, 95% CI: 0.02–1.63, P = 0.088). Only one patient in Group D experienced transient hypoxemia lasting less than 10 s. The onset of sedation was much faster in Group R than Group D (105 ± 21 s vs. 599 ± 172 s, P < 0.01). Two patients in Group D did not reach the target sedative level in 15 min after sedative infusion. All patients reached a MOAA/S score of 5 upon completion of the dental implant surgery. However, patients in Group D had a higher incidence of delayed discharge than those in Group R (16.2% vs. 2.7%, P = 0.047).

Conclusions

Both remimazolam and dexmedetomidine can provide satisfactory sedation with minimal inhibition on respiratory function in elderly patients undergoing dental implant surgery. However, remimazolam is superior to dexmedetomidine, offering better hemodynamic stability, faster onset of sedation, and quicker recovery.

Trial registration

This study was registered at the Chinese Clinical Trials Registry (Registration ID: ChiCTR2400083062; Registration date: April 15, 2024).