Department of Anesthesiology, The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu, Sichuan, China.
Department of Anesthesiology, Chengdu Second People's Hospital, Chengdu, Sichuan, China.
Med Sci Monit. 2024 Sep 21;30:e944632. doi: 10.12659/MSM.944632.
BACKGROUND Awake endotracheal intubation (AEI) involves the placement of an endotracheal tube in patients who can maintain spontaneous respirations. This retrospective study aimed to compare sedation with remimazolam during AEI with that of dexmedetomidine in patients who underwent scoliosis correction surgery. MATERIAL AND METHODS This is a retrospective study based on data from 98 patients who had AEI procedures between January and December 2023. The remimazolam group included 55 patients, and the dexmedetomidine group included 43 patients. Remimazolam 0.05 mg/kg was injected 1 min before intubation, while dexmedetomidine 1 ug/kg was pumped 10 min before intubation. Evaluations of AEI, hemodynamics, and respiratory adverse events were then compared between the 2 groups. RESULTS There was no significant difference in demographic data between the groups. After administrating sedation, dexmedetomidine led to a larger reduction of mean arterial pressure (MAP) and heart rate (HR) than did remimazolam (11.30±1.86 vs 8.33±2.28 mmHg, P<0.001; 12.28±2.50 vs 2.85±1.82 beats/min, P<0.001). When conducting intubation, the increase of MAP in the remimazolam group was lower than that in the dexmedetomidine group (7.40±2.81 vs 9.26±5.08 mmHg, P=0.024), while the difference in HR change was not significant (7.53±5.41 vs 8.37±5.31 beats/min, P=0.441). When combined with local anesthesia, the success rate of AEI, time of AEI procedure, attempt times, increase of MAP during intubation, depth of sedation, and respiratory adverse events were comparable between the groups (P>0.05). CONCLUSIONS With local anesthesia, remimazolam and dexmedetomidine sedation can facilitate AEI for patients with scoliosis. However, remimazolam is associated with more stable hemodynamics.
清醒气管插管（AEI）涉及到对能够自主呼吸的患者进行气管插管。本回顾性研究旨在比较瑞马唑仑镇静与右美托咪定镇静在接受脊柱侧凸矫正手术的患者中的作用。
这是一项基于 2023 年 1 月至 12 月期间进行 AEI 手术的 98 例患者数据的回顾性研究。瑞马唑仑组 55 例，右美托咪定组 43 例。插管前 1 分钟注射瑞马唑仑 0.05mg/kg，插管前 10 分钟泵注右美托咪定 1ug/kg。比较两组的 AEI 、血流动力学和呼吸不良事件。
两组患者的一般资料无统计学差异。给予镇静后，与瑞马唑仑相比，右美托咪定导致平均动脉压（MAP）和心率（HR）的降低更为明显（11.30±1.86 与 8.33±2.28mmHg，P<0.001；12.28±2.50 与 2.85±1.82 次/分，P<0.001）。在插管过程中，瑞马唑仑组 MAP 的升高低于右美托咪定组（7.40±2.81 与 9.26±5.08mmHg，P=0.024），而 HR 变化的差异无统计学意义（7.53±5.41 与 8.37±5.31 次/分，P=0.441）。在联合局部麻醉时，两组 AEI 成功率、AEI 时间、尝试次数、插管期间 MAP 升高、镇静深度和呼吸不良事件无显著差异（P>0.05）。
在局部麻醉下，瑞马唑仑和右美托咪定镇静均可促进脊柱侧凸患者的 AEI。然而，瑞马唑仑与更稳定的血流动力学相关。
