Abstract
PURPOSE: To investigate the clinical efficacy of remifentanil mild sedation versus propofol deep sedation for anesthesia during painless gastroscopy. METHODS: A total of 980 patients undergoing painless gastroscopy at our hospital's endoscopy center from January to May 2025 were enrolled and randomly divided into a control group (490 cases, propofol-etomidate mixture intravenous injection) and an observation group (490 cases, remifentanil intravenous injection) using a computer-generated random sequence with sealed envelope allocation. Intraoperative vital sign changes, complication rates, time to ambulation, anesthetic dosage, and patient satisfaction were compared between the two groups. RESULTS: The overall complication rate in the observation group was 0.6%, significantly lower than 64% in the control group (P < 0.05). 76.3% of patients in the observation group experienced intraoperative blood pressure and heart rate fluctuations, compared to 78.6% in the control group, with no significant difference (P > 0.05). The observation group demonstrated significantly shorter ambulation time (17 ± 1.8 vs. 25 ± 3.6 min, P < 0.01) and higher satisfaction rates (patients: 92% vs. 94.4%; clinicians: 98% vs. 95%, P < 0.05) than the control group. Multivariate logistic regression analysis showed that remifentanil use was an independent factor for reducing complications (OR = 0.12, 95%CI:0.05-0.28, P < 0.001). CONCLUSION: Remifentanil intravenous injection combined with lidocaine gel for mild sedation anesthesia effectively alleviates discomfort during gastroscopy. Compared with propofol-based deep sedation, it demonstrates a lower complication rate and higher safety.