Supplemental Material for: Efficacy and safety of remimazolam sedation for gastrointestinal endoscopy in elderly versus non-elderly patients

ASA-PS class I was less common in the elderly group (26.3% vs. 65.0%, p=0.025), whereas the upper/lower GI endoscopy ratio did not differ (12/7 vs. 8/12, p=0.205). Total remimazolam dose was significantly lower in the elderly group (3.7 ± 0.9 vs. 5.7 ± 1.6 mg, p<0.001). More elderly patients were sedated with the initial dose alone (52.6% vs. 5.0%, p=0.001).

Time to awakening (1.9 ± 3.5 vs. 0.8 ± 1.8 min, p=0.205) and ambulation (3.9 ± 3.7 vs. 2.0 ± 2.5 min, p=0.077) did not differ significantly. Adverse events were observed only in the elderly group (4/19 [21.1%] vs. 0/20, p=0.047), including hypoxemia (n=2), hypertension (n=1), and hypotension (n=1), all of which were mild and resolved with minimal intervention.</p><p dir="ltr">Conclusion: Remimazolam provided effective sedation for GI endoscopy, and elderly patients received a lower total dose under the study protocol.

Although these adverse events were mild and resolved with minimal intervention, their occurrence in elderly patients warrants careful monitoring. These exploratory findings warrant confirmation in adequately powered prospective studies. </p>