瑞马唑仑和瑞芬太尼复合诱导和维持全静脉麻醉，不使用神经肌肉阻滞剂：一项前瞻性、观察性的初步研究。
Total intravenous anesthesia induced and maintained by a combination of remimazolam and remifentanil without a neuromuscular blocking agent: a prospective, observational pilot study.
机构信息
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumi 173, Bundang, Seongnam, Gyeonggi, 13620, Republic of Korea.
出版信息
BMC Anesthesiol. 2022 Jul 26;22(1):237. doi: 10.1186/s12871-022-01779-2.
BACKGROUND
A novel short-acting benzodiazepine, Remimazolam, has recently been approved for general anesthesia and sedation. Hence, we investigated the feasibility and safety of remimazolam during the induction and maintenance of general anesthesia without using a neuromuscular blocking agent (NMBA) in patients undergoing hysteroscopic surgery.
METHODS
This prospective observational study included 38 patients undergoing hysteroscopic surgery. Remimazolam and remifentanil were the main anesthetic agents without an NMBA, and a supraglottic airway was inserted to protect the airway. The induction time, amount of each anesthetic agent used during anesthesia, intraoperative bispectral index (BIS) hemodynamic parameters, and recovery profiles were measured.
RESULTS
General anesthesia was successfully administered to 37 patients using remimazolam and remifentanil without NMBA. The induction doses of remimazolam and remifentanil were 0.4 mg/kg (interquartile range [IQR] 0.34-0.47 mg/kg) and 1.07 μg/kg (IQR, 0.90-1.29 μg/kg), respectively. Additionally, the maintenance doses of remimazolam and remifentanil were 1.14 mg/kg/h (IQR, 0.88-1.55 mg/kg/h) and 0.06 μg/kg/min (IQR, 0.04-0.08 μg/kg/min), respectively. Intraoperative BIS values had risen temporarily > 60 in eight patients (21.6%) despite administration of 2 mg/kg/h of remimazolam; thus, they were treated with supplementary midazolam. The median recovery time was 7 min (IQR, 5-8 min) after 40 min (IQR, 40.0-57.5 min) of total mean anesthesia time. There was no correlation between the infusion dose of remimazolam and recovery profiles, such as recovery time, final BIS of anesthesia, modified observer assessment of alertness/sedation (OAA/S) scale or post-anesthesia recovery (PAR) score when arriving at the PACU, and length of stay in the PACU (all P > 0.05).
CONCLUSION
Remimazolam can be combined with remifentanil without an NMBA in female patients who undergo hysteroscopic surgery, during which a supraglottic airway is a feasible method to protect the airway.
TRIAL REGISTRATION
The study protocol was registered at ClinicalTrials.gov (NCT05025410) on 27/08/2021.
背景
一种新型短效苯二氮䓬类药物，瑞马唑仑，最近已被批准用于全身麻醉和镇静。因此，我们研究了在不使用神经肌肉阻滞剂（NMBA）的情况下，瑞马唑仑在宫腔镜手术患者全麻诱导和维持中的可行性和安全性。
方法
这是一项前瞻性观察研究，纳入 38 例行宫腔镜手术的患者。瑞马唑仑和瑞芬太尼是主要的麻醉剂，不使用 NMBA，并插入声门上气道以保护气道。测量麻醉诱导时间、麻醉期间使用的每种麻醉剂的剂量、术中双频谱指数（BIS）血流动力学参数和恢复情况。
结果
37 例患者成功使用瑞马唑仑和瑞芬太尼（无 NMBA）进行全麻。瑞马唑仑和瑞芬太尼的诱导剂量分别为 0.4mg/kg（四分位距[IQR]0.34-0.47mg/kg）和 1.07μg/kg（IQR，0.90-1.29μg/kg）。此外，瑞马唑仑和瑞芬太尼的维持剂量分别为 1.14mg/kg/h（IQR，0.88-1.55mg/kg/h）和 0.06μg/kg/min（IQR，0.04-0.08μg/kg/min）。尽管给予 2mg/kg/h 的瑞马唑仑，但仍有 8 名患者（21.6%）的术中 BIS 值暂时升高至>60，因此给予了补充咪达唑仑。在总平均麻醉时间为 40 分钟（IQR，40.0-57.5 分钟）后，中位数恢复时间为 7 分钟（IQR，5-8 分钟）。瑞马唑仑输注剂量与恢复情况（如恢复时间、麻醉终末 BIS、改良警觉/镇静评估量表（OAA/S）或到达 PACU 时的麻醉后恢复（PAR）评分以及 PACU 停留时间）之间无相关性所有 P>0.05）。
结论
在接受宫腔镜手术的女性患者中，瑞马唑仑可与瑞芬太尼联合使用，不使用 NMBA，此时使用声门上气道是一种可行的保护气道的方法。
试验注册
该研究方案于 2021 年 8 月 27 日在 ClinicalTrials.gov（NCT05025410）注册。
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