Tsukimoto Shota, Kitaura Atsuhiro, Yamamoto Rina, Hirase Chikara, Nakao Shinichi, Nakajima Yasufumi, Sanuki Takuro
Department of Dental Anesthesiology, Kanagawa Dental University, Yokosuka, JPN.
Department of Anesthesiology, Kindai University, Osaka, JPN.
Cureus. 2024 Apr 15;16(4):e58340. doi: 10.7759/cureus.58340. eCollection 2024 Apr.
Hypotension is common during anesthesia induction. However, minimal hemodynamic effects of remimazolam anesthesia have been reported. We hypothesized that remimazolam would have weaker hemodynamic effects than would propofol. To test this, we simultaneously evaluated the hemodynamics using the estimated continuous cardiac output (esCCO) system and heart rate variability (HRV) during anesthesia induction.
This was a single-center, observational, retrospective study of patients undergoing dental surgery under general anesthesia between 2020 and 2022. Seventy patients were divided into two groups: remimazolam (R group; n=34) and propofol (P group; n=36). The information obtained from the anesthesia records, patient information, esCCO system parameters, and HRV were integrated and analyzed. The percentages of various parameters were set to 100% for the pre-induction phase as the baseline.
The %MAP (noninvasive mean arterial blood pressure) decreased over a narrower range in the R compared to the P group (-17.8% (-26.3%, -11.9%) vs. -22.6% (-32.9%, -17.0%); P=0.039). The %HR (heart rate) increased significantly in the R group and decreased in the P group (+10.7% (+6.5%, +18.6%) vs. -6.5% (-14.5%, +8.4%); P<0.01). The %SV (stroke volume calculated using the esCCO system) decreased significantly in both groups, but the R group showed a smaller difference compared to the P group (- 5.1% (-7.7%, -2.1%) vs. -10.0% (-13.8%, -5.6%); P<0.01). The rates of change in %LF nu (normalized unit of low frequency) and %HF nu (normalized unit of high frequency) were lower for the R than for the P group, although the difference was not significant (+6.8% (-14.5%, 32.4%) vs. +9.2% (-7.2%, +59.7%), P=0.30; +7.9% (-51.0%, +66.9%) vs. +22.8% (-26.1%, +61.6%), P=0.57).
Remimazolam demonstrated a lower MAP reduction rate than propofol. A compensatory increase in HR occurred with a decrease in stroke volume. However, the HR increase was not attributable to the autonomic nervous system.
麻醉诱导期间低血压很常见。然而，已有报道称瑞马唑仑麻醉对血流动力学的影响最小。我们假设瑞马唑仑的血流动力学效应比丙泊酚弱。为验证这一点，我们在麻醉诱导期间使用估计连续心输出量（esCCO）系统和心率变异性（HRV）同时评估血流动力学。
这是一项对2020年至2022年期间接受全身麻醉下牙科手术患者的单中心、观察性、回顾性研究。70例患者分为两组：瑞马唑仑组（R组；n = 34）和丙泊酚组（P组；n = 36）。整合并分析从麻醉记录、患者信息、esCCO系统参数和HRV中获得的信息。将诱导前阶段各种参数的百分比设定为100%作为基线。
与P组相比，R组的%MAP（无创平均动脉血压）下降范围更窄（-17.8%（-26.3%，-11.9%） vs. -22.6%（-32.9%，-17.0%）；P = 0.039）。R组的%HR（心率）显著升高，而P组降低（+10.7%（+6.5%，+18.6%） vs. -6.5%（-14.5%，+8.4%）；P < 0.01）。两组的%SV（使用esCCO系统计算的每搏输出量）均显著下降，但R组与P组相比差异较小（-5.1%（-7.7%，-2.1%） vs. -10.0%（-13.8%，-5.6%）；P < 0.01）。R组的%LF nu（低频标准化单位）和%HF nu（高频标准化单位）的变化率低于P组，尽管差异不显著（+6.8%（-14.5%，32.4%） vs. +9.2%（-7.2%，+59.7%），P = 0.30；+7.9%（-51.0%，+66.9%） vs. +22.8%（-26.1%，+61.6%），P = 0.57）。
瑞马唑仑的MAP降低率低于丙泊酚。随着每搏输出量的减少，心率出现代偿性增加。然而，心率增加并非归因于自主神经系统。
