Department of Anesthesiology, Kindai University Faculty of Medicine, Osaka 586-0001, Japan.
Medicina (Kaunas). 2023 Dec 8;59(12):2136. doi: 10.3390/medicina59122136.
: Remimazolam is a new ultrashort-acting benzodiazepine anesthetic. Remimazolam appears to be useful in patients with severe valvular disease because of its minimal cardiovascular impact. In this retrospective case series study, we assessed the efficacy and safety of remimazolam for maintaining hemodynamic stability during anesthetic induction and maintenance. : MitraClip was performed on 18 cases with severe mitral regurgitation with low left ventricular function who presented with heart failure, and remimazolam was administered for general anesthesia with induction (12 mg/kg/h) and maintenance (1 mg/kg/h). The impact of remimazolam on the hemodynamics at anesthetic induction and during anesthetic maintenance was investigated retrospectively using electronic medical records. Blood pressure decreased significantly during anesthetic induction with remimazolam (78.5 [72, 81.25] and 66.1 [62.2, 74.2], median [IQR], = 0.0001), but only mildly, by about 10 mmHg. There was no significant change in the cardiac index (2.0 [1.8, 2.4] vs. 1.9 [1.8, 2.3], = 0.57642) or pulse rate (73.5 ± 8.85 vs. 74.7 ± 11.7, mean ± SD, = 0.0876) during anesthetic induction with remimazolam. All patients underwent MitraClip without major hemodynamic concerns, with no or small increases in inotropes. Remimazolam may be used safely in patients with severe mitral regurgitation and low left ventricular function presenting with heart failure.
: 瑞马唑仑是一种新型超短效苯二氮䓬类麻醉剂。由于其对心血管系统的影响较小，瑞马唑仑似乎对患有严重瓣膜病的患者有用。在这项回顾性病例系列研究中，我们评估了瑞马唑仑在维持麻醉诱导和维持期间血流动力学稳定方面的疗效和安全性。 : 18 例严重二尖瓣反流伴左心室功能低下且心力衰竭的患者接受了二尖瓣夹合术，给予瑞马唑仑全身麻醉，诱导（12 mg/kg/h）和维持（1 mg/kg/h）。使用电子病历回顾性研究瑞马唑仑对麻醉诱导和麻醉维持期间血流动力学的影响。瑞马唑仑诱导时血压显著下降（78.5 [72, 81.25] 和 66.1 [62.2, 74.2]，中位数 [IQR]， = 0.0001），但仅轻度下降约 10 mmHg。心指数（2.0 [1.8, 2.4] 与 1.9 [1.8, 2.3]， = 0.57642）或脉搏率（73.5 ± 8.85 与 74.7 ± 11.7，均值 ± 标准差， = 0.0876）在瑞马唑仑诱导时均无显著变化。所有患者均在无或小剂量使用正性肌力药物的情况下成功接受了二尖瓣夹合术，无重大血流动力学问题。 : 对于伴有心力衰竭的严重二尖瓣反流和左心室功能低下的患者，瑞马唑仑可能是安全的。
