Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Gyeonggi Province, Republic of Korea.
J Clin Anesth. 2024 Nov;98:111580. doi: 10.1016/j.jclinane.2024.111580. Epub 2024 Aug 9.
There is scarce evidence on the hemodynamic stability of remimazolam during anesthetic induction in patients with significant coronary artery disease. This study aims to compare the effects of remimazolam and propofol on post-induction hypotension in patients undergoing coronary artery bypass grafting (CABG).
Randomized controlled trial.
Tertiary teaching hospital.
Adult patients undergoing isolated CABG.
Patients were randomly allocated to received either remimazolam (n = 50) or propofol (n = 50) for anesthetic induction. The remimazolam group received an initial infusion at 6 mg/kg/h, which was later adjusted to 1-2 mg/kg/h to maintain a bispectral index of 40-60 after loss of consciousness. In the propofol group, a 1.5 mg/kg bolus of propofol was administered, followed by 1-1.5% sevoflurane inhalation as needed to achieve the target bispectral index.
The primary outcome was the area under the curve (AUC) below the baseline mean arterial pressure (MAP) during the first 10 min after anesthetic induction. Secondary outcomes included the AUC for MAP <65 mmHg and the requirement for vasopressors.
The remimazolam group demonstrated a significantly lower AUC under the baseline MAP compared to the propofol group (mean [SD], 169.8 [101.0] mmHg·min vs. 220.6 [102.4] mmHg·min; mean difference [95% confidence interval], 50.8 [10.4-91.2] mmHg·min; P = 0.014). Additionally, the remimazolam group had a reduced AUC for MAP <65 mmHg (7.3 [10.3] mmHg·min vs. 13.9 [14.9] mmHg·min; P = 0.007) and a lower frequency of vasopressor use compared to the propofol group (60% vs. 88%, P = 0.001).
Remimazolam may offer improved hemodynamic stability during anesthetic induction in patients undergoing CABG, suggesting its potential advantage over propofol for patients with significant coronary artery disease in terms of hemodynamic stability.
在患有严重冠状动脉疾病的患者中，咪达唑仑诱导麻醉期间的血流动力学稳定性证据稀缺。本研究旨在比较瑞马唑仑和丙泊酚对冠状动脉旁路移植术（CABG）患者诱导后低血压的影响。
随机对照试验。
三级教学医院。
接受单纯 CABG 的成年患者。
患者被随机分配接受瑞马唑仑（n=50）或丙泊酚（n=50）进行麻醉诱导。瑞马唑仑组以 6mg/kg/h 的初始输注，在意识丧失后调整至 1-2mg/kg/h 以维持 40-60 的双频谱指数。丙泊酚组给予 1.5mg/kg 的丙泊酚推注，然后根据需要给予 1-1.5%七氟醚吸入以达到目标双频谱指数。
主要结局是麻醉诱导后 10min 内 MAP 基线以下的曲线下面积（AUC）。次要结局包括 MAP<65mmHg 的 AUC 和血管加压药的需求。
与丙泊酚组相比，瑞马唑仑组的 MAP 基线以下 AUC 显著降低（平均[标准差]，169.8[101.0]mmHg·min 与 220.6[102.4]mmHg·min；平均差值[95%置信区间]，50.8[10.4-91.2]mmHg·min；P=0.014）。此外，瑞马唑仑组 MAP<65mmHg 的 AUC 减少（7.3[10.3]mmHg·min 与 13.9[14.9]mmHg·min；P=0.007），与丙泊酚组相比，使用血管加压药的频率降低（60%与 88%，P=0.001）。
瑞马唑仑可能在 CABG 患者麻醉诱导期间提供更好的血流动力学稳定性，表明其在血流动力学稳定性方面可能优于丙泊酚，适用于患有严重冠状动脉疾病的患者。
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