Department of Anesthesiology and Pain Medicine, Wonju College of Medicine, Yonsei University, Ilsan-Ro 20, Wonju-Si, Gangwon-Do, 26426, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Wonju Severance Christian Hospital, Wonju-Si, Gangwon-Do, South Korea.
BMC Anesthesiol. 2023 Jun 22;23(1):219. doi: 10.1186/s12871-023-02188-9.
Certain routine medication could result in post-induction hypotension (PIH), such as angiotensin axis blockades, which are frequently administered as a first-line therapy against hypertension. Remimazolam is reportedly associated with lesser intraoperative hypotension than propofol. This study compared the overall incidence of PIH following remimazolam or propofol administration in patients managed by angiotensin axis blockades.
This single-blind, parallel-group, randomized control trial was conducted in a tertiary university hospital in South Korea. Patients undergoing surgery with general anesthesia were considered for enrollment if the inclusion criteria were met: administration of an angiotensin converting enzyme inhibitor or angiotensin receptor blocker, 19 to 65 years old, American Society of Anesthesiologists physical status classification ≤ III, and no involvement in other clinical trials. The primary outcome was the overall incidence of PIH, defined as a mean blood pressure (MBP) < 65 mmHg or decrease by ≥ 30% of the baseline MBP. The time points of measurement were baseline, just before the initial intubation attempt, and 1, 5, 10, and 15 min following intubation. The heart rate, systolic and diastolic blood pressures, and bispectral index were also recorded. Groups P and R included patients administered propofol and remimazolam, respectively, as an induction agent.
A total of 81 patients were analyzed, of the 82 randomized patients. PIH was less frequent in group R than group P (62.5% versus 82.9%; t value 4.27, P = 0.04, adjusted odds ratio = 0.32 [95% confidence interval 0.10-0.99]). The decrease in the MBP from baseline was 9.6 mmHg lesser in group R than in group P before the initial intubation attempt (95% confidence interval 3.3-15.9). A similar trend was observed for systolic and diastolic blood pressures. No severe adverse events were observed in either group.
Remimazolam results in less frequent PIH than propofol in patients undergoing routine administration of angiotensin axis blockades.
This trial was retrospectively registered on Clinical Research Information Service (CRIS), Republic of Korea (KCT0007488). Registration date: 30/06/2022.
某些常规药物会导致诱导后低血压（PIH），例如血管紧张素轴阻滞剂，这些药物通常被用作治疗高血压的一线药物。雷米佐仑据报道与丙泊酚相比术中低血压发生率较低。本研究比较了在接受血管紧张素轴阻滞剂治疗的患者中，使用雷米佐仑或丙泊酚后 PIH 的总发生率。
这是一项在韩国一家三级大学医院进行的单盲、平行组、随机对照试验。如果符合以下纳入标准，接受全身麻醉手术的患者将被考虑入组：使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂、19 至 65 岁、美国麻醉医师协会身体状况分类≤III 级、且未参与其他临床试验。主要结局是 PIH 的总发生率，定义为平均血压（MBP）<65mmHg 或基线 MBP 下降≥30%。测量时间点为基线、初始插管尝试前、插管后 1、5、10 和 15 分钟。还记录了心率、收缩压和舒张压以及双频谱指数。组 P 和组 R 分别包含接受丙泊酚和雷米佐仑作为诱导剂的患者。
共分析了 81 名患者，这 82 名随机患者中的 81 名。与组 P 相比，组 R 中 PIH 的发生率较低（62.5%比 82.9%；t 值 4.27，P=0.04，调整后的优势比=0.32[95%置信区间 0.10-0.99]）。与组 P 相比，在初始插管尝试前，组 R 的 MBP 从基线下降了 9.6mmHg（95%置信区间 3.3-15.9）。收缩压和舒张压也呈现出类似的趋势。两组均未观察到严重不良事件。
在常规使用血管紧张素轴阻滞剂的患者中，雷米佐仑导致的 PIH 发生率低于丙泊酚。
该试验在韩国临床研究信息服务（CRIS）上进行了回顾性注册（KCT0007488）。注册日期：2022 年 6 月 30 日。
