Department of Anesthesiology, The Second Clinical Medical College, North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China.
Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.
BMC Anesthesiol. 2024 Mar 8;24(1):94. doi: 10.1186/s12871-024-02468-y.
Remimazolam is a novel ultrashort-acting intravenous benzodiazepine sedative-hypnotic. The combination of remimazolam and sevoflurane does not increase respiratory sensitivity, produce bronchospasm, or cause other adverse conditions. We aimed to observe the effects of different remimazolam doses on the minimum alveolar concentration (MAC) of sevoflurane at end-expiration during laryngeal mask insertion and evaluate the effect of sex on the efficacy of the combination of remimazolam on the suppression of laryngeal mask insertion in adult patients.
We included 240 patients undergoing laparoscopic surgery under general anesthesia with elective placement of a laryngeal mask (120 males and 120 females). The patients were randomly divided into four groups according to sex: a control group (randomization for female patients, RF0; randomization for male patients, RM0) and three remimazolam groups (RF1, RM1 / RM2, RF2 / RM3, RF3), with 30 patients in each group. Induction was established by vital capacity rapid inhalation induction (VCRII), using 8% sevoflurane and 100% oxygen (6 L/min) in all patients. The (RF1, RM1), (RM2, RF2), and (RM3, RF3) groups were continuously injected with remimazolam at doses of 1, 1.5, and 2.0 mg/kg/h, respectively, while the (RM0, RF0) group was injected with an equal volume of normal saline. The end-expiratory concentration of sevoflurane was adjusted to a preset value after the patient's eyelash reflex disappeared. After the end-expiratory concentration of sevoflurane was kept stable for at least 15 min, the laryngeal mask was placed, and the patient's physical response to the mask placement was observed immediately and within 30 s of placement. The MAC of sevoflurane was measured using the up-and-down sequential method of Dixon.
The calculated MAC of end-expiratory sevoflurane during laryngeal mask insertion in adult females was (2.94 ± 0.18)%, (2.69 ± 0.16)%, (2.32 ± 0.16)% and (1.83 ± 0.15)% in groups RF0, RF1, RF2 and RF3; (2.98 ± 0.18)%, (2.80 ± 0.19)%, (2.54 ± 0.15)% and (2.15 ± 0.15)% in male groups RM0, RM1, RM2 and RM3, respectively. The MAC values were significantly lower in the (RF1-RF3, RM1-RM3) group when compared to the (RF0, RM0) group. There was no significant difference between (RF0, RF1) and (RM0, RM1), but the MAC value of the RF2-RF3 group was significantly lower than that of the RM2-RM3 group.
Remimazolam can effectively reduce end-expiratory sevoflurane MAC values during laryngeal mask placement in adults. When remimazolam was measured above 1.5 mg/kg/h, the effect of inhibiting laryngeal mask implantation in female patients was stronger than that in male patients. Remimazolam at a dose of 1-2 mg/kg/h combined with sevoflurane induction can be safely and effectively used in these patients.
瑞马唑仑是一种新型超短效静脉苯二氮䓬类镇静催眠药。瑞马唑仑与七氟醚联合使用不会增加呼吸敏感性、引发支气管痉挛或引起其他不良情况。我们旨在观察不同瑞马唑仑剂量对喉罩置入时呼气末七氟醚最低肺泡浓度（MAC）的影响，并评估性别对瑞马唑仑抑制成人患者喉罩插入效果的影响。
我们纳入了 240 例行腹腔镜手术的患者，这些患者在全身麻醉下择期放置喉罩（男性 120 例，女性 120 例）。患者根据性别随机分为四组：对照组（女性患者随机分组，RF0；男性患者随机分组，RM0）和三个瑞马唑仑组（RF1、RM1/RM2、RF2/RM3，每组 30 例）。所有患者均采用容量控制快速吸入诱导（VCRII），使用 8%七氟醚和 100%氧气（6 L/min）。（RF1、RM1）、（RM2、RF2）和（RM3、RF3）组分别连续注射 1、1.5 和 2.0 mg/kg/h 的瑞马唑仑，而（RM0、RF0）组注射等量生理盐水。当患者的睫毛反射消失后，调整呼气末七氟醚浓度至预设值。在呼气末七氟醚浓度稳定至少 15 min 后，放置喉罩，并立即观察患者对喉罩放置的生理反应，以及放置后 30 s 内的反应。采用 Dixon 的上下序贯法测量七氟醚的 MAC 值。
成年女性 RF0、RF1、RF2 和 RF3 组喉罩置入时呼气末七氟醚的计算 MAC 值分别为（2.94±0.18）%、（2.69±0.16）%、（2.32±0.16）%和（1.83±0.15）%；RM0、RM1、RM2 和 RM3 组男性的分别为（2.98±0.18）%、（2.80±0.19）%、（2.54±0.15）%和（2.15±0.15）%。与（RF0、RM0）组相比，（RF1-RF3、RM1-RM3）组的 MAC 值明显降低。（RF0、RF1）和（RM0、RM1）之间没有显著差异，但 RF2-RF3 组的 MAC 值明显低于 RM2-RM3 组。
瑞马唑仑可有效降低成人喉罩置入时呼气末七氟醚 MAC 值。当瑞马唑仑剂量超过 1.5 mg/kg/h 时，抑制女性患者喉罩植入的效果强于男性患者。瑞马唑仑 1-2 mg/kg/h 联合七氟醚诱导可安全有效地用于这些患者。
