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ObjectiveTo observe the safety and effectiveness of low-dose remidazolam combined with propofol in painless gastroenterscopy in elderly patients. MethodsA total of 120 elderly patients who underwent painless gastroenteroscopy in Hebei General Hospital from February 2022 to July 2022 were selected. Patients were randomly divided into group C(1.5mg/kg propofol), group R1(0.05mg/kg remidazolam combined with 1mg/kg propofol) and group R2(0.1mg/kg remidazolam combined with 1mg/kg propofol), 40 patients in each group. The values of SBP, DBP, HR, SpO2 and bispectral index(BIS) were recorded at four time points: after the patient entering the room(T1), the MOAA/S score being 0 after anesthesia induction(T2), the gastroscope being inserted(T3) and the end of examination(T4). The success rate of sedation, dosage of propofol, the time of endoscopy examation, awakening time, and time of leaving the recovery room, the satisfaction of patients and operating physician were recorded. The adverse reactions during and after operation were observed and recorded. ResultsCompared with T1, HR, SBP, DBP and BIS values of three groups were significantly decreased at T2, T3 and T4(P＜0.05). At T2, the values of SBP, DBP and BIS in group R1 and group R2 were significantly higher than those in group C(P＜0.05). There were statistically significant differences in the dosage of propofol, the time of awakening, the time of leaving the room (F=164.904, 29.878, 89.058, P＜0.05) and the incidence of hypoxemia, Hypotension, hiccup, body motion reaction and injection pain (χ2=8.772, 11.563, 9.697, 8.607, 21.943, P＜0.05) among the three groups. Compared with group C, in R1 and R2 group the total dosage of propofol reduced significantly(P＜0.05), the time for awakening and leaving recovery room shortened(P＜0.05), the incidence of hiccups increased(P＜0.05), while the incidences of hypoxemia, body movement reaction, hypotension and injection pain reduced significantly(P＜0.05). ConclusionA combined propofol anesthetic regimen with remazolam, which can stably maintain hemodynamic changes, reduce the amount of propofol, shorten the time of awakening and leauing recovery room, and reduce the incidence of adverse effects. It can be safely and effectively applied to elderly patients during painless gastrointestinal endoscopy. Rimazoparin 0.05 mg/kg is associated with a lower incidence of hiccups than 0.1 mg/kg, has less impact on the operating physician, and the protocol is more optimal.

Purpose: Currently, there is no favorable treatment plan for inflammatory pain, so exploring new analgesics is still a research hotspot in this area. Cyclin-dependent protein kinase 5 (Cdk5) is a pain-related protein kinase, but its mechanism in inflammatory pain has not been clarified. This research aimed to explore the mechanism of Cdk5-synaptophysin (Syn)-soluble N-ethylmaleimide-sensitivity factor (NSF) attachment protein receptor (SNARE) in acute and chronic inflammatory pain., Methods: Rat models of acute and chronic inflammatory pain were induced by formalin and complete Freund's adjuvant (CFA), separately, and some rats injected with normal saline through intraplantar injection were divided into a control group. Thirty minutes before modeling, rats were given Cdk5 inhibitor (Roscovitine, Ros), SNARE scavenger (botulinum toxin A, BTTA), glutamate receptor inhibitor (MK801), and dimethyl sulfoxide (DMSO) through spinal canals, and the paw withdrawal threshold (PWT) and thermal withdrawal latency (PWL) at difference time points were compared., Results: Compared with rats in the control group, those in the rat models of acute and chronic inflammatory pain showed lower PWT and PWL, higher Cdk5 enzyme level, tight correlation of Cdk5 with Syn, SNARE, p25 proteins, and higher levels of Cdk5, Syn and SNARE. And the above situation was dramatically reversed under intervention of Ros, BTTA and MK801., Conclusion: Cdk5-Syn-SNARE pathway is a therapeutic target for inflammatory pain. Blocking the activation of this pathway is beneficial to exert analgesic effect., Competing Interests: None., (AJTR Copyright © 2021.)