Department of Anesthesiology and Intensive Care Medicine, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan.
BMC Anesthesiol. 2021 Dec 6;21(1):306. doi: 10.1186/s12871-021-01530-3.
Remimazolam, a novel benzodiazepine, has been reported to cause less hypotension than propofol during induction of anesthesia. Therefore, remimazolam might be a valuable option in elderly patients with severe aortic stenosis who are considered to be the most vulnerable to hemodynamic instability. We aimed to evaluate the feasibility and hemodynamic effects of remimazolam as an induction agent in elderly patients with severe aortic stenosis.
This prospective, open-label, single-arm, observational pilot study was conducted in a university hospital between November 2020 and April 2021. We included 20 patients aged 65 years or older scheduled for transcatheter or surgical aortic valve replacement for severe aortic stenosis under general anesthesia. Patients were administered intravenous remimazolam infusion at 6 mg/kg/h combined with 0.25 μg/kg/min of remifentanil infusion. The primary outcome was the vasopressor dosage between the induction of anesthesia and the completion of tracheal intubation. The secondary outcomes included hemodynamic changes, bispectral index changes, and the time from the start of remimazolam infusion to loss of consciousness. We also recorded awareness during anesthesia induction and serious adverse events related to death, life-threatening events, prolonged hospitalizations, and disability due to permanent damage.
Twenty patients aged 84 [79-86] (median [interquartile range]) with American Society of Anesthesiologists physical status 4 were analyzed. Ephedrine 0 [0-4] mg and phenylephrine 0.1 [0-0.1] mg were administered to 14/20 patients (3 doses in 1 patient, 2 doses in 4 patients, and one dose in 9 patients). Loss of consciousness was achieved at 80 [69-86] s after the remimazolam infusion was started. The mean arterial pressure decreased gradually after loss of consciousness but recovered immediately after tracheal intubation. The bispectral index values gradually decreased and reached < 60 at 120 s after loss of consciousness. Neither awareness during induction of anesthesia nor serious adverse events, such as severe bradycardia (< 40 bpm), life-threatening arrhythmia, myocardial ischemia, or anaphylactic reactions were observed.
Remimazolam could be used as an induction agent with timely bolus vasopressors in elderly patients with severe aortic stenosis.
UMIN Clinical Trials Registry, identifier UMIN000042318 .
咪达唑仑是一种新型苯二氮䓬类药物，据报道其在麻醉诱导时引起的低血压比丙泊酚少。因此，咪达唑仑可能是严重主动脉瓣狭窄老年患者的一个有价值的选择，这些患者被认为最容易出现血流动力学不稳定。我们旨在评估咪达唑仑作为诱导剂在严重主动脉瓣狭窄老年患者中的可行性和血流动力学效应。
这是一项在 2020 年 11 月至 2021 年 4 月期间在一所大学医院进行的前瞻性、开放标签、单臂、观察性试验研究。我们纳入了 20 名年龄在 65 岁或以上的患者，这些患者因严重主动脉瓣狭窄接受全身麻醉下的经导管或外科主动脉瓣置换术。患者接受 6mg/kg/h 的静脉咪达唑仑输注，同时输注 0.25μg/kg/min 的瑞芬太尼。主要结局是麻醉诱导期间和气管插管完成期间血管加压药的剂量。次要结局包括血流动力学变化、脑电双频指数变化以及咪达唑仑输注开始至意识丧失的时间。我们还记录了麻醉诱导期间的意识和与死亡、危及生命的事件、延长住院时间和永久性损害导致的残疾相关的严重不良事件。
对 20 名年龄为 84[79-86]岁（中位数[四分位数范围]）、美国麻醉医师协会身体状况 4 级的患者进行了分析。14/20 名患者（1 名患者用了 3 剂，4 名患者用了 2 剂，9 名患者用了 1 剂）给予了麻黄碱 0[0-4]mg 和去氧肾上腺素 0.1[0-0.1]mg。咪达唑仑输注开始后 80[69-86]s 达到意识丧失。意识丧失后平均动脉压逐渐下降，但气管插管后立即恢复。脑电双频指数值逐渐下降，意识丧失后 120s 时降至<60。在诱导期间没有意识，也没有观察到严重的不良事件，如严重心动过缓（<40bpm）、危及生命的心律失常、心肌缺血或过敏反应。
咪达唑仑可作为严重主动脉瓣狭窄老年患者的诱导剂，及时使用血管加压药。
UMIN 临床研究注册，标识符 UMIN000042318。
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