Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164 Worldcup-Ro, Yeongtong-Gu, Suwon, 16499, Republic of Korea.
Office of Biostatics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea.
BMC Anesthesiol. 2023 Mar 16;23(1):81. doi: 10.1186/s12871-023-02041-z.
Remimazolam is a new anesthetic drug developed and is an ultra-short-acting agent with rapid onset and offset. The pharmacology of this drug seems to be ideal for short surgeries eligible for I-gel insertion. Therefore, this study aimed to determine the optimal bolus dose of remimazolam for I-gel insertion when co-administered with remifentanil without neuromuscular blocking agents (NMBAs).
Patients aged 19-65 years with American Society of Anesthesiologists physical status I or II scheduled for general anesthesia were enrolled. The first dose of remimazolam was 0.15 mg/kg and remifentanil was co-administered at an effect-site concentration (Ce) of 3.0 ng/mL. The dose of remimazolam for the following patient was decreased or increased by 0.05 mg/kg depending on the success or failure of I-gel insertion in the previous patient.
The remimazolam bolus dose required for successful I-gel insertion in 50% of adult patients using modified Dixon's up-and-down method with remifentanil Ce 3.0 ng/mL and no NMBAs was 0.280 ± 0.048 mg/kg. Isotonic regression analysis showed that the 50% and 95% effective doses were 0.244 (83% confidence interval [CI] 0.213-0.313) mg/kg and 0.444 (95% CI 0.436-0.448) mg/kg, respectively. The mean time to loss of consciousness (Modified Observer's Assessment of Alertness/Sedation score < 2) was 52.2 s. Three patients (12.0%) showed a reduction in systolic blood pressure of more than 30% from baseline.
Selecting the appropriate dose of remimazolam/remifentanil without NMBAs makes it feasible to insert the I-gel.
This study protocol was registered at http://cris.nih.go.kr (KCT0007801, 12th, October, 2022).
雷米唑仑是一种新的麻醉药物，具有起效迅速、消除迅速的特点。这种药物的药理学似乎非常适合适合插入 I-gel 的短手术。因此，本研究旨在确定在没有神经肌肉阻滞剂 (NMBAs) 的情况下，与瑞芬太尼联合使用时，雷米唑仑用于 I-gel 插入的最佳推注剂量。
纳入年龄在 19-65 岁之间、ASA 身体状况 I 或 II 级、拟行全身麻醉的患者。首剂量为 0.15mg/kg 雷米唑仑，同时给予瑞芬太尼效应部位浓度 (Ce) 为 3.0ng/mL。根据前一位患者 I-gel 插入的成功或失败，下一位患者的雷米唑仑剂量减少或增加 0.05mg/kg。
采用改良 Dixon 上下法，使用雷米唑仑 Ce 3.0ng/mL 和无 NMBAs 时，50%成人患者成功插入 I-gel 所需的雷米唑仑推注剂量为 0.280±0.048mg/kg。等张回归分析显示，50%和 95%有效剂量分别为 0.244（83%可信区间 [CI] 0.213-0.313）mg/kg 和 0.444（95% CI 0.436-0.448）mg/kg。意识丧失（改良观察者评估警觉/镇静评分<2）的平均时间为 52.2s。3 名患者（12.0%）的收缩压从基线下降超过 30%。
选择合适的雷米唑仑/瑞芬太尼剂量（无 NMBAs）可使 I-gel 插入变得可行。
本研究方案在 http://cris.nih.go.kr 注册（KCT0007801，2022 年 10 月 12 日）。
