Jia Z, Ren L X, Fan Y T, Tan Z M
Department of Anesthesiology, Affiliated Hainan Cancer Hospital of Hainan Medical College, Hai Kou 570100, China.
Zhonghua Yi Xue Za Zhi. 2021 Mar 23;101(11):813-816. doi: 10.3760/cma.j.cn112137-20200901-02524.
To estimate the safety and efficacy of remimazolam tosilate used for moderate-to-deep sedation in fiberoptic bronchoscopy with its 50% effective dosage (ED50) and 95% effective dosage (ED95) calculated. A total of 50 patients aged from 18 to 65 years and classified as Class Ⅰ or Ⅱ according to the American Society of Anesthesiologists (ASA) Classification who underwent fiberoptic bronchoscopy in Hainan Cancer Hospital from April to August of 2020 were included in this study. For each patient, bronchoscopy was only started when the eyelash reflex disappeared and MOAA/S score was<1 after a trial dose of remimazolam tosilate combined with 0.1 μg/kg sufentanil was intravenously given. The dosage of remimazolam tosilate for the first patient was 0.18 mg/kg, based on which the dosages for the following patients were increased or decreased by 1∶1 times for one another, forming an equal ratio sequence. A maintenance dose of remimazolam tosilate was pumped intravenously in a rate of 1 mg/(kg·h) during the bronchoscopic examination and treatment. The result of the sequential trial, the time to achieve proper sedation, the analepsia time and the adverse effects were recorded. All the 50 patients went through bronchoscopy completely. The regression function of the sequential trial was =12.589+16.593, the ED50 and the ED95 of remimazolam tosilate were 0.174 (95%: 0.162-0.186) mg/kg and 0.219 (95%: 0.199-0.312) mg/kg, respectively. The time to achieve proper sedation was (50±11) s and the mean analepsia time after the use of flumazenil was (56±16) s. There was one patient with respiratory inhibition, one with headache and dizziness, one with fatigue among the 50 patients. The strategy of moderate-to-deep sedation based on remimazolam tosilate is safe and effective in bronchoscopic examination and treatment. When combined with 0.1 μg/kg sufentanil, the ED50 and the ED95 of remimazolam tosilate are 0.174 mg/kg and 0.219 mg/kg, respectively.
评估甲苯磺酸瑞马唑仑用于纤维支气管镜检查中、深度镇静的安全性和有效性，并计算其半数有效剂量（ED50）和95%有效剂量（ED95）。本研究纳入了2020年4月至8月在海南肿瘤医院接受纤维支气管镜检查的50例年龄在18至65岁之间、根据美国麻醉医师协会（ASA）分级为Ⅰ或Ⅱ级的患者。对于每例患者，在静脉给予甲苯磺酸瑞马唑仑试验剂量联合0.1μg/kg舒芬太尼后，当睫毛反射消失且MOAA/S评分<1时才开始进行支气管镜检查。首例患者甲苯磺酸瑞马唑仑的剂量为0.18mg/kg，在此基础上，后续患者的剂量以1∶1的倍数相互增减，形成等比数列。在支气管镜检查和治疗期间，以1mg/（kg·h）的速率静脉泵注甲苯磺酸瑞马唑仑维持剂量。记录序贯试验结果、达到适当镇静的时间、苏醒时间及不良反应。50例患者均顺利完成支气管镜检查。序贯试验的回归方程为=12.589+16.593，甲苯磺酸瑞马唑仑的ED50和ED95分别为0.174（95%：0.162 - 0.186）mg/kg和0.219（95%：0.199 - 0.312）mg/kg。达到适当镇静的时间为（50±11）s，使用氟马西尼后的平均苏醒时间为（56±16）s。50例患者中，1例出现呼吸抑制，1例出现头痛头晕，1例出现乏力。基于甲苯磺酸瑞马唑仑的中、深度镇静策略在支气管镜检查和治疗中安全有效。与0.1μg/kg舒芬太尼合用时，甲苯磺酸瑞马唑仑的ED50和ED95分别为0.174mg/kg和0.219mg/kg。
