Kim Tae Kwang, Kwak Hyun Jeong, Jung Wol Seon, Choi Gyu Bin, Park Sung Yong, Kim Jong Yeop
Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea.
Department of Anaesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon 21565, Republic of Korea.
J Clin Med. 2023 Aug 14;12(16):5285. doi: 10.3390/jcm12165285.
Remimazolam has advantages such as hemodynamic stability and rapid onset. We investigated the effects of induction doses on hemodynamics and recovery profiles for remimazolam compared to propofol in older patients. Sixty-nine patients aged >65 years were randomly assigned to either the propofol anesthesia group (P group) or the remimazolam anesthesia group with an induction dose of 6 mg/kg/h (R6 group) or 12 mg/kg/h (R12 group), followed by 1 mg/kg/h. P group was anesthetized with 4 µg/mL of propofol effect-site concentration (Ce) with target-control infusion, followed by 2.5-3 µg/mL of Ce. The primary outcome was the difference between the baseline mean arterial pressure (MAP) and the lowest MAP during anesthesia (ΔMAP). ΔMAP was comparable between the P, R6, and R12 groups (43.8 ± 13.8 mmHg, 39.2 ± 14.3 mmHg, and 39.2 ± 13.5 mmHg, = 0.443). However, the frequencies of vasoactive drug use were 54.5%, 17.4%, and 30.4% ( = 0.029), and the median doses of ephedrine 3 (0-6) mg, 0 (0-0) mg, and 0 (0-0) mg ( = 0.034), which were significantly different. This study showed remimazolam anesthesia with an induction dose of 6 mg/kg/h, rather than 12 mg/kg/h, could reduce the requirement for vasoactive drugs compared to propofol anesthesia.
瑞马唑仑具有血流动力学稳定和起效迅速等优点。我们研究了在老年患者中，与丙泊酚相比，诱导剂量对瑞马唑仑血流动力学和恢复情况的影响。69名年龄大于65岁的患者被随机分配到丙泊酚麻醉组（P组）或诱导剂量为6mg/kg/h的瑞马唑仑麻醉组（R6组）或12mg/kg/h的瑞马唑仑麻醉组（R12组），随后以1mg/kg/h维持。P组采用目标控制输注4μg/mL丙泊酚效应室浓度（Ce）进行麻醉，随后Ce为2.5 - 3μg/mL。主要结局是基线平均动脉压（MAP）与麻醉期间最低MAP之间的差值（ΔMAP）。P组、R6组和R12组之间的ΔMAP具有可比性（分别为43.8±13.8mmHg、39.2±14.3mmHg和39.2±13.5mmHg，P = 0.443）。然而，血管活性药物的使用频率分别为54.5%、17.4%和30.4%（P = 0.029），麻黄碱的中位剂量分别为3（0 - 6）mg、0（0 - 0）mg和0（0 - 0）mg（P = 0.034），差异有统计学意义。本研究表明，与丙泊酚麻醉相比，诱导剂量为6mg/kg/h而非12mg/kg/h的瑞马唑仑麻醉可降低血管活性药物的需求。
