Background: Remimazolam tosilate is a new ultra-short-acting benzodiazepine sedative medicine. In this study, we evaluated the effect of remimazolam tosilate on the incidence of hypoxemia during sedation in elderly patients undergoing gastrointestinal endoscopy.Methods: Patients in the remimazolam group received an initial dose of 0.1 mg/kg and a bolus dose of 2.5 mg of remimazolam tosilate, whereas patients in the propofol group received an initial dose of 1.5 mg/kg and a bolus dose of 0.5 mg/kg of propofol. Patients received ASA standard monitoring (heart-rate, non-invasive blood pressure, and pulse oxygen saturation) during the entire examination process. The primary outcome was the incidence of moderate hypoxemia (defined as 85%≤ SpO₂< 90%, >15s) during the gastrointestinal endoscopy. The secondary outcomes included the incidence of mild hypoxemia (defined as SpO₂ 90%–94%) and severe hypoxemia (defined as SpO₂< 85%, >15s), the lowest pulse oxygen saturation, airway maneuvers used to correct hypoxemia, patient’s hemodynamic as well as other adverse events.Results: 107 elderly patients (67.6 ± 5.7 years old) in the remimazolam group and 109 elderly patients (67.5 ± 4.9 years old) in the propofol group were analyzed. The incidence of moderate hypoxemia was 2.8% in the remimazolam group and 17.4% in the propofol group (relative risk [RR] = 0.161; 95% confidence interval [CI], 0.049 to 0.528; p < 0.001). The frequency of mild hypoxemia was less in the remimazolam group, but not statistically significant (9.3% vs. 14.7%; RR = 0.637; 95% CI, 0.303 to 1.339; p = 0.228). There was no significant difference in the incidence of severe hypoxemia between the two groups (4.7% vs. 5.5%; RR = 0.849; 95% CI, 0.267 to 2.698; p = 0.781). The median lowest SpO₂ during the examination was 98% (IQR, 96.0%–99.0%) in patients in the remimazolam group, which was significantly higher than in patients in the propofol group (96%, IQR, 92.0%–99.0%, p < 0.001). Patients in the remimazolam group received more drug supplementation during endoscopy than patients in the propofol group (p = 0.014). There was a statistically significant difference in the incidence of hypotension between the two groups (2.8% vs. 12.8%; RR = 0.218; 95% CI, 0.065 to 0.738; p = 0.006). No significant differences were found in the incidence of adverse events such as nausea and vomiting, dizziness, and prolonged sedation.Conclusion: This study explored the safety of remimazolam compared with propofol during gastrointestinal endoscopy in elderly patients. Despite the increased supplemental doses during sedation, remimazolam improved risk of moderate hypoxemia (i.e., 85%≤ SpO₂ < 90%) and hypotension in elderly patients.

Background: By continually monitoring end-tidal carbon dioxide concentrations, capnography can detect abnormal ventilation or apnoea early. This randomized, controlled study explored the effect of early intervention with capnography on the incidence of hypoxia in mildly obese patients undergoing sedation for esophagogastroduodenoscopy (EGD) and colonoscopy. Methods: This is a single-center, randomized, single-blind, parallel-assignment, controlled trial. Mildly obese patients (28 kg/m² ≤ BMI < 40 kg/m²) undergoing sedation for EGD and colonoscopy were randomly assigned to either the standard or capnography group. Standard cardiopulmonary monitoring equipment was used in both groups, and additional capnography was performed in the capnography group. In the event of inadequate alveolar ventilation during sedation, five interventions were administered in sequence (a-e) : a: increasing oxygen flow (5 L/min); b: a chin lift or jaw thrust maneuver; c: placement of the nasopharyngeal airway and chin lift; d: mask positive-pressure ventilation, and e: ventilator-assisted ventilation with tube insertion. The primary outcome was the incidence of hypoxia (SpO₂ < 90%, ≥ 10 s) in each group. The secondary outcomes included the incidence of severe hypoxia (SpO₂ ≤ 85%), subclinical respiratory depression (90% ≤ SpO₂ < 95%), interventions, minimum SpO₂ during operation, patient satisfaction, endoscopist satisfaction, and other adverse events of anesthesia sedation. Results: 228 patients were included (capnography group = 112; standard group = 113; three patients were excluded) in this study. The incidence of hypoxia was significantly lower in the capnography group than in the standard group (13.4% vs. 30.1%, P = 0.002). Subclinical respiratory depression in the capnography group was higher than that of the standard group (30.4% vs. 17.7%, P = 0.026). There was only a 5.4% incidence of severe hypoxia in the capnography group compared with 14.2% in the standard group (P = 0.026). During sedation, 96 and 34 individuals in the capnography and standard groups, respectively, underwent the intervention. There was a statistically significant difference (P < 0.0001) in the number of the last intraoperative intervention between the two groups ( a:47 vs. 1, b:46 vs. 26, c:2 vs. 5, d:1 vs. 2, e:0 vs. 0 ). No significant differences were found between the two groups in terms of minimum SpO₂ during operation, patient satisfaction, or endoscopist satisfaction rating. There was no statistically significant difference in adverse events of anesthesia sedation between the two groups. Conclusion: Capnography during sedation for EGD and colonoscopy allows for the detection of apnea and altered breathing patterns in mildly obese patients before SpO₂ is reduced. Effective intervention measures are given to patients within this time frame, which reduces the incidence of hypoxia and severe hypoxia in patients. Trial registration: Ethical approval was granted by the Medical Ethics Committee (Chairperson Professor Tian Hui) of Qilu Hospital, Shandong University ((Ke) Lun Audit 2021 (186)) on 15/07/2021. The study was registered (https://www.chictr.org.cn) on 23/10/2021(ChiCTR2100052234). Designed and reported using CONSORT statements.

Renal ischemia-reperfusion injury (IRI) is a major pathological driver of acute kidney injury (AKI), for which effective therapeutic strategies remain lacking. Recently, novel forms of programmed cell death (PCD), including pyroptosis, ferroptosis, cuproptosis and necroptosis, have been identified as key mediators of tubular damage and inflammation in renal IRI. This review delineates a hierarchically organized and spatiotemporally regulated PCD network, positioning it as a central determinant of cellular fate following renal IRI. We systematically characterize the distinct molecular signatures of each death modality and critically examine their extensive crosstalk within the pathological renal microenvironment. Synthesizing current evidence, we demonstrate that this network operates in a cell type- and phase-specific manner, driving a vicious cycle of inflammation and oxidative stress. Targeting this interconnected network rather than isolated pathways represents a paradigm shift. We critically assess current therapeutic strategies and their limitations in the context of this network. Finally, we propose a forward-looking roadmap that emphasizes combination therapies guided by spatial transcriptomics, patient stratification using PCD-specific biomarkers and the development of smart nanosystems capable of dynamically modulating key network nodes. Deciphering and therapeutically intervening in this PCD network is pivotal for developing effective treatments for renal IRI.

Respiratory depression and airway obstruction are the most common respiratory adverse reactions in elderly patients undergoing gastroenteroscopy under sedation. Additionally, sharing the airway with endoscopists can complicate airway management. Here, we plan to apply COMBO (Capnography Monitoring Bite Block Oxygenation) endoscopy of the oropharyngeal airway, a novel airway management device with integrated capnography monitoring and dual oxygenation support, to investigate the incidence of adverse events such as hypoxaemia and airway obstruction in elderly patients during anaesthesia, providing a reference for airway management in clinical practice. This will be a prospective, randomized, controlled clinical study. We will enrol 164 elderly patients (aged 65–80 years) scheduled for painless gastroenteroscopy. The participants will be randomly assigned to two groups. In the experimental group, an oropharyngeal airway designed for gastroscopy will be used. The control group will receive an ordinary endoscopic bite block. The primary outcome measure will be the incidence of hypoxia (75% ≤ SpO2 < 90%, ≤ 60 s), and the secondary outcome measures will be the incidence of severe hypoxia (SpO2 < 75% or 75% ≤SpO2 < 90%, ≥ 60 s); incidence of circulatory fluctuations [severe bradycardia (< 50 beats/min), a mean arterial pressure (MAP) fluctuation greater than 30% of the baseline value or an MAP < 60 mmHg]; incidence of airway intervention; dose of additional drugs administered during the procedure; endoscopist satisfaction; and incidence of various adverse events. This clinical study aims to evaluate whether an oropharyngeal airway dedicated to gastroscopy can effectively maintain airway patency and alleviate retrolingual collapse, thereby preventing hypoxaemia. It also aims to determine whether it can reduce the incidence of respiratory-related adverse events. This clinical trial protocol was formally registered at ClinicalTrials.gov (Registration Number: NCT06711328) on November 26, 2024.

Background: A significant reduction in regional cerebral oxygen saturation (rSO₂) is commonly observed during one-lung ventilation (OLV), while positive end-expiratory pressure (PEEP) can improve oxygenation. We compared the effects of three different PEEP levels on rSO₂, pulmonary oxygenation, and hemodynamics during OLV. Methods: Forty-three elderly patients who underwent thoracoscopic lobectomy were randomly assigned to one of six PEEP combinations which used a crossover design of 3 levels of PEEP—0 cmH₂O, 5 cmH₂O, and 10 cmH₂O. The primary endpoint was rSO₂ in patients receiving OLV 20 min after adjusting the PEEP. The secondary outcomes included hemodynamic and respiratory variables. Results: After exclusion, thirty-six patients (36.11% female; age range: 60–76 year) were assigned to six groups (n = 6 in each group). The rSO₂ was highest at OLV(0) than at OLV(10) (difference, 2.889%; [95% CI, 0.573 to 5.204%]; p = 0.008). Arterial oxygen partial pressure (PaO₂) was lowest at OLV(0) compared with OLV(5) (difference, -62.639 mmHg; [95% CI, -106.170 to -19.108 mmHg]; p = 0.005) or OLV(10) (difference, -73.389 mmHg; [95% CI, -117.852 to -28.925 mmHg]; p = 0.001), while peak airway pressure (Ppeak) was lower at OLV(0) (difference, -4.222 mmHg; [95% CI, -5.140 to -3.304 mmHg]; p < 0.001) and OLV(5) (difference, -3.139 mmHg; [95% CI, -4.110 to -2.167 mmHg]; p < 0.001) than at OLV(10). Conclusions: PEEP with 10 cmH₂O makes rSO₂ decrease compared with 0 cmH₂O. Applying PEEP with 5 cmH₂O during OLV in elderly patients can improve oxygenation and maintain high rSO₂ levels, without significantly increasing peak airway pressure compared to not using PEEP. Trial registration: Chinese Clinical Trial Registry ChiCTR2200060112 on 19 May 2022.