摘要BACKGROUND:Remimazolam is a novel ultra-short-acting sedative,but its safety and adverse events(AEs)in high-risk patients in the intensive care unit(ICU)setting remain unknown.METHODS:This was a single-center,retrospective study that compared remimazolam to propofol and midazolam in patients undergoing upper gastrointestinal endoscopy.The primary outcome was the incidence of treatment-related AEs.The secondary outcomes were the time to extubation,the length of ICU stay,and the average cost of sedative per case.RESULTS:Of the 88 patients analyzed,47 were treated with remimazolam(mean dose,7.90±4.84 mg),and 41 were treated with propofol(21.19±17.98 mg)or midazolam(3.08±2.17 mg).There was no statistically significant difference in the average duration of the endoscopic procedure(35.89±13.37 min vs.44.51±21.68 min,P=0.133)or the time to extubation(15.00±9.75 h vs.20.59±18.71 h,P=0.211)in the remimazolam group(group I)compared to the propofol or midazolam group(group II).ICU stays(5.40±2.93 d vs.4.63±3.31 d,P=0.072)and treatment-related AEs(48.61%vs.51.38%,P=0.056)were similar between groups.The average cost of sedative per case was signifi cantly lower in the group I than in the group II(RMB 16.07±10.58 yuan vs.RMB 24.37±15.46 yuan,P=0.016).CONCLUSION:Remimazolam-based sedation was noninferior to the classic sedatives and had lower average cost per case,indicating that it may be used as a promising sedative for high-risk patients during endoscopic procedures in the ICU setting.