Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong Hospital, Gyeonggi-do, Republic of Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Chung-Ang University, Seoul, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyukwan University School of Medicine, Seoul, Republic of Korea.
J Clin Anesth. 2023 Nov;90:111223. doi: 10.1016/j.jclinane.2023.111223. Epub 2023 Jul 26.
The emergence profiles in patients undergoing total intravenous anesthesia with either propofol or remimazolam with flumazenil reversal were compared.
A prospective, double-blind, randomized trial.
An operating room and a post-anesthesia care unit (PACU).
Adult patients (n = 100) having American Society of Anesthesiologists (ASA) physical status of I-III undergoing general anesthesia were enrolled and randomly assigned to the propofol or the remimazolam group.
The propofol group received target-controlled infusion of propofol, and the remimazolam group received continuous infusion of remimazolam. Continuous infusion of remifentanil was used in both groups. For emergence, flumazenil was used in increments of 0.2 mg in the remimazolam group.
The primary outcome was the time required for the patient to obey verbal commands. The secondary outcomes included the time to bispectral index (BIS) over 80, the time to laryngeal mask airway (LMA) removal, the Richmond Agitation-Sedation Scale (RASS) scores in the PACU, and adverse events throughout the study period.
The time taken to obey verbal commands was significantly longer in the propofol group than the remimazolam group (14 [9, 19]) vs. 5 [3, 7]) minutes, P < 0.001; median difference -9, 95% confidence interval -11 to -6). The times to BIS over 80 and to LMA removal were also significantly longer in the propofol group. In addition, the RASS score upon arrival to the PACU differed significantly between the two groups (P = 0.006). Re-sedation in the PACU was observed in 11 (22%) of the patients in the remimazolam group.
Remimazolam-based total intravenous anesthesia with flumazenil reversal may be effective in reducing emergence time, but a significant incidence of re-sedation was observed in the PACU. Further studies are needed to determine adequate dose and timing of routine flumazenil use and minimize the risk of re-sedation.
比较丙泊酚或依托咪酯复合氟马西尼逆转全静脉麻醉患者的苏醒特征。
前瞻性、双盲、随机试验。
手术室和麻醉后恢复室（PACU）。
纳入并随机分配至丙泊酚组或依托咪酯组的全麻下 ASA 分级 I-III 级的成年患者（n=100）。
丙泊酚组给予丙泊酚靶控输注，依托咪酯组给予依托咪酯持续输注。两组均给予瑞芬太尼持续输注。依托咪酯组在苏醒时每 0.2mg 递增使用氟马西尼。
主要结局为患者服从口头指令所需的时间。次要结局包括 BIS 超过 80 的时间、喉罩移除时间、PACU 中的 Richmond 躁动-镇静量表（RASS）评分以及整个研究期间的不良事件。
与依托咪酯组（5[3,7]min）相比，丙泊酚组服从口头指令的时间明显延长（14[9,19]min），P<0.001；中位数差-9，95%置信区间-11 至-6）。BIS 超过 80 和喉罩移除的时间也明显延长。此外，两组患者到达 PACU 时的 RASS 评分差异有统计学意义（P=0.006）。依托咪酯组 11 例（22%）患者在 PACU 中需要再次镇静。
依托咪酯复合氟马西尼逆转的全静脉麻醉可能有助于缩短苏醒时间，但在 PACU 中观察到显著的再镇静发生率。需要进一步研究确定常规氟马西尼使用的适当剂量和时机，以最小化再镇静的风险。
