咪达唑仑-氟马西尼麻醉较丙泊酚-氟马西尼麻醉在老年脊柱手术患者中能更快苏醒：一项随机对照试验。
Remimazolam-based anesthesia with flumazenil allows faster emergence than propofol-based anesthesia in older patients undergoing spinal surgery: A randomized controlled trial.
机构信息
Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima, Japan.
Department of Anesthesiology, JA Hiroshima General Hospital, Hiroshima, Japan.
出版信息
Medicine (Baltimore). 2023 Nov 17;102(46):e36081. doi: 10.1097/MD.0000000000036081.
BACKGROUND
Remimazolam is a novel, ultrashort-acting benzodiazepine that can be antagonized by flumazenil. This study aimed to determine whether remimazolam-based anesthesia with flumazenil provides a more rapid emergence than propofol-based anesthesia in older patients undergoing spinal surgery.
METHODS
This was a prospective, single-blind, randomized controlled trial. Forty-four patients > 75 years old who had undergone spinal surgery were enrolled in this study. They were randomly assigned to the remimazolam or propofol group (1:1) using a computer randomization system stratified by age and body weight. For anesthesia induction and maintenance, remifentanil was administered at a defined dose in both groups, and remimazolam or propofol was adjusted to maintain the bispectral index or state entropy monitoring within 40-60. All anesthetics were discontinued simultaneously after the postoperative X-ray and 0.5 mg flumazenil was administered to the remimazolam group. The primary outcome was extubation time after discontinuing anesthesia, and the secondary outcomes were time to eye opening, obeying commands, and achieving a white fast-track score (WFTS) of 12.
RESULTS
Thirty-nine patients were finally analyzed: remimazolam group (n = 20), propofol group (n = 19). There were no significant differences in intraoperative variables, such as operative time, anesthesia time, and patient background, between the 2 groups. Extubation times were significantly shorter in the remimazolam group than in the propofol group (4 vs 8 minutes, P < .001). The time to eye opening, obeying commands, and achieving a WFTS of 12 were significantly shorter in the remimazolam group (P < .001, for all comparisons).
CONCLUSION
Remimazolam-based anesthesia with flumazenil resulted in a faster emergence than propofol-based anesthesia in older patients undergoing spinal surgery.
背景
瑞马唑仑是一种新型的超短效苯二氮䓬类药物，可用氟马西尼拮抗。本研究旨在确定在接受脊柱手术的老年患者中，瑞马唑仑联合氟马西尼麻醉与丙泊酚联合氟马西尼麻醉相比，是否能更快苏醒。
方法
这是一项前瞻性、单盲、随机对照试验。本研究纳入了 44 名年龄>75 岁、接受脊柱手术的患者。他们采用计算机随机化系统按年龄和体重分层，分为瑞马唑仑组或丙泊酚组（1:1）。两组均采用瑞芬太尼固定剂量进行麻醉诱导和维持，调整瑞马唑仑或丙泊酚的用量，使脑电双频指数或状态熵监测值维持在 40-60。两组患者均在术后 X 线检查后同时停止所有麻醉药物，瑞马唑仑组给予 0.5mg 氟马西尼。主要结局指标为停止麻醉后的拔管时间，次要结局指标为睁眼时间、听从指令时间和达到 WFTS 评分 12 分的时间。
结果
最终分析了 39 例患者：瑞马唑仑组（n=20），丙泊酚组（n=19）。两组患者术中变量，如手术时间、麻醉时间和患者背景等，无显著差异。瑞马唑仑组的拔管时间明显短于丙泊酚组（4 分钟比 8 分钟，P<0.001）。瑞马唑仑组的睁眼时间、听从指令时间和达到 WFTS 评分 12 分的时间明显短于丙泊酚组（P<0.001，所有比较）。
结论
在接受脊柱手术的老年患者中，瑞马唑仑联合氟马西尼麻醉比丙泊酚联合氟马西尼麻醉苏醒更快。
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