Department of Anaesthesiology, Mengcheng County No. 1 People's Hospital, Mengcheng, 233500, Anhui Province, P.R. China.
BMC Anesthesiol. 2023 Jun 12;23(1):199. doi: 10.1186/s12871-023-02164-3.
Although the operation time of hysteroscopy is short, the incidence of postoperative nausea and vomiting is high. The aim of this study was to compare the incidence of postoperative nausea and vomiting in hysteroscopy when remimazolam is combined with remifentanil or alfentanil.
We conducted a randomized, controlled, double-blind trial. Patients undergoing hysteroscopy were recruited and randomly assigned to either the remimazolam-remifentanil (Group RR) or the remimazolam-alfentanil group (Group RA). All patients in the two groups were started with an induction dose of remimazolam besylate 0.2 mg/kg and then maintained with a dosage of 1.0 mg/kg/h. After induction with remimazolam besylate, in Group RR, remifentanil was infused using a target-controlled infusion system with a target concentration of 1.5 ng/ml and titrated throughout the procedure. In Group RA, infusion of alfentanil was started with an initial bolus dose of 20 µg/kg over 30 s and then maintained at an initial rate of 0.16 µg/kg/min. The primary observation outcome was the incidence rate of postoperative nausea and vomiting. The secondary observation outcomes were the time to awakening, the length of stay in the PACU, the total remimazolam dose and adverse effects, such as low SpO, bradycardia, hypotension and body movement.
A total of 204 patients were successfully included in this study. The incidence of postoperative nausea and vomiting in Group RR (2/102, 2.0%) was significantly lower than that in Group RA (12/102, 11.8%) (p < 0.05). There was no significant difference in the incidence of adverse events, such as low SpO, bradycardia, hypotension and body movement, between Groups RR and RA (p > 0.05).
Remimazolam-remifentanil causes less postoperative nausea and vomiting than remimazolam-alfentanil in hysteroscopy.
Clinical trial registration number: ChiCTR2100044177. Full date of the first registration: 12/03/2021.
虽然宫腔镜手术时间短，但术后恶心呕吐的发生率较高。本研究旨在比较咪达唑仑复合瑞芬太尼或阿芬太尼用于宫腔镜时术后恶心呕吐的发生率。
我们进行了一项随机、对照、双盲试验。招募接受宫腔镜检查的患者，并随机分为咪达唑仑-瑞芬太尼组（RR 组）或咪达唑仑-阿芬太尼组（RA 组）。两组患者均给予咪达唑仑琥珀酸盐 0.2mg/kg 的诱导剂量，然后以 1.0mg/kg/h 的剂量维持。咪达唑仑琥珀酸盐诱导后，RR 组采用靶控输注系统输注瑞芬太尼，靶浓度为 1.5ng/ml，并在整个过程中进行滴定。RA 组以 20μg/kg 的初始剂量静脉注射阿芬太尼 30s，然后以 0.16μg/kg/min 的初始速率维持。主要观察结局为术后恶心呕吐发生率。次要观察结局为苏醒时间、PACU 停留时间、咪达唑仑总剂量及低 SpO、心动过缓、低血压和躯体运动等不良反应。
共有 204 例患者成功纳入本研究。RR 组（2/102，2.0%）术后恶心呕吐发生率明显低于 RA 组（12/102，11.8%）（p<0.05）。RR 组和 RA 组在低 SpO、心动过缓、低血压和躯体运动等不良反应的发生率方面无显著差异（p>0.05）。
与咪达唑仑-阿芬太尼相比，宫腔镜术中咪达唑仑-瑞芬太尼引起的术后恶心呕吐更少。
临床试验注册号：ChiCTR2100044177。首次注册日期：2021 年 12 月 03 日。
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