School of Anesthesiology, Guizhou Medical University, Guiyang City, Guizhou Province, People's Republic of China.
Department of Anesthesiology, Affiliated Hospital of Guizhou Medical University, Guiyang City, Guizhou Province, People's Republic of China.
Drug Des Devel Ther. 2023 Sep 27;17:2943-2953. doi: 10.2147/DDDT.S425590. eCollection 2023.
Remimazolam tosilate (RT) is a novel ultrashort-acting γ-aminobutyric acid subtype A (GABA) agonist, with several advantages including rapid induction and recovery, stable haemodynamics, and mild respiratory inhibition. However, studies have not been conducted to explore the haemodynamic effects of RT in elderly hypertensive subjects undergoing non-cardiac surgery. Therefore, we sought to compare the effects of anaesthesia induction using different doses of RT and etomidate on the haemodynamics of this group of patients.
Patients were recruited into this single-center, prospective, randomized, double-blind trial from October 2022 to June 2023. A total of 150 hypertensive elderly undergoing non-cardiac surgery were randomly assigned into 0.2 mg/kg RT group (Group RL), 0.3 mg/kg RT group (Group RH) and 0.3 mg/kg etomidate group (Group E). The primary outcome of the study was haemodynamic changes (mean arterial pressure fluctuation value -∆MAP and heart rate fluctuation value -∆HR) observed during anaesthesia induction. Secondary outcomes included incidence of adverse cardiovascular events and adverse drug reactions (injection pain and myoclonus), cumulative doses of vasoactive drugs and vital signs at different time points.
Patients in Group E and Group RL had significantly lower haemodynamic fluctuations (∆MAP), lower incidence of hypotension and cumulative dose of ephedrine than subjects in Group RH. Patients in groups RL and RH had significantly lower incidence of injection pain and myoclonus compared with patients in group E. The results showed no statistically significant differences in ∆HR, hypertension, bradycardia, tachycardia, and time to loss of eye-opening reflex and start of intubation, and vital signs at different time points among the three groups.
Use of low-dose RT (0.2 mg/kg) for induction of non-cardiac surgical anaesthesia in elderly hypertensive patients is more effective in maintaining haemodynamic stability and has fewer adverse effects compared with etomidate.
甲苯磺酸瑞马唑仑（RT）是一种新型的超短效 γ-氨基丁酸 A 型（GABA）受体激动剂，具有诱导和恢复迅速、血流动力学稳定、呼吸抑制轻微等优点。然而，目前尚未有研究探讨 RT 在接受非心脏手术的老年高血压患者中的血流动力学效应。因此，我们旨在比较不同剂量 RT 和依托咪酯诱导麻醉对该组患者血流动力学的影响。
本研究为单中心、前瞻性、随机、双盲临床试验，于 2022 年 10 月至 2023 年 6 月期间招募了 150 名拟行非心脏手术的高血压老年患者，随机分为 0.2mg/kg RT 组（RL 组）、0.3mg/kg RT 组（RH 组）和 0.3mg/kg 依托咪酯组（E 组）。研究的主要结局为麻醉诱导期间观察到的血流动力学变化（平均动脉压波动值 -∆MAP 和心率波动值 -∆HR）。次要结局包括心血管不良事件和药物不良反应（注射痛和肌阵挛）的发生率、血管活性药物的累积剂量以及不同时间点的生命体征。
E 组和 RL 组患者的血流动力学波动（∆MAP）更低，低血压发生率和麻黄碱累积剂量均低于 RH 组。RL 组和 RH 组患者的注射痛和肌阵挛发生率明显低于 E 组。三组患者的 ∆HR、高血压、心动过缓、心动过速、意识丧失反射消失时间和插管开始时间以及不同时间点的生命体征均无统计学差异。
与依托咪酯相比，在老年高血压患者的非心脏手术麻醉诱导中使用低剂量 RT（0.2mg/kg）更能有效维持血流动力学稳定，且不良反应更少。
