Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK.
Anesthesiology Department, Systems Pharmacology Effect Control and Modelling Research Group, Hospital Clinic de Barcelona, Barcelona, Spain; Neuroscience Department, NeuroImmunology Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
Br J Anaesth. 2021 Jul;127(1):41-55. doi: 10.1016/j.bja.2021.03.028. Epub 2021 May 6.
Anaesthesiologists and non-anaesthesiologist sedationists have a limited set of available i.v. hypnotics, further reduced by the withdrawal of thiopental in the USA and its near disappearance in Europe. Meanwhile, demand for sedation increases and new clinical groups are using what traditionally are anaesthesiologists' drugs. Improved understanding of the determinants of perioperative morbidity and mortality has spotlighted hypotension as a potent cause of patient harm, and practice must be adjusted to respect this. High-dose propofol sedation may be harmful, and a critical reappraisal of drug choices and doses is needed. The development of remimazolam, initially for procedural sedation, allows reconsideration of benzodiazepines as the hypnotic component of a general anaesthetic even if their characterisation as i.v. anaesthetics is questionable. Early data suggest that a combination of remimazolam and remifentanil can induce and maintain anaesthesia. Further work is needed to define use cases for this technique and to determine the impact on patient outcomes.
麻醉师和非麻醉镇静师可用的静脉内催眠药物有限，在美国硫喷妥钠被撤出，在欧洲几乎消失，这进一步减少了可用药物的数量。与此同时，镇静需求增加，新的临床群体正在使用传统上属于麻醉师的药物。对围手术期发病率和死亡率决定因素的认识的提高使低血压成为导致患者伤害的一个重要原因，必须调整实践以尊重这一点。大剂量异丙酚镇静可能有害，需要对药物选择和剂量进行批判性重新评估。瑞马唑仑的开发最初用于程序镇静，这使得人们重新考虑将苯二氮䓬类药物作为全身麻醉的催眠成分，即使它们被定性为静脉内麻醉药是有问题的。早期数据表明，瑞马唑仑和瑞芬太尼的组合可以诱导和维持麻醉。需要进一步的工作来定义这种技术的用例，并确定对患者结局的影响。
