Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Drug Des Devel Ther. 2024 Nov 12;18:5149-5159. doi: 10.2147/DDDT.S480734. eCollection 2024.
Pharmacokinetic and pharmacodynamic (PKPD) models exist for remimazolam, but data for target-controlled infusion (TCI) are limited. The Schüttler PKPD model, a three-compartment model including body weight as a covariate, does not account for age as a variable. This study aimed to investigate remimazolam's effect-site concentration (Ce) in different age groups during sedation and general anesthesia with TCI using Schüttler PKPD model.
Records of patients who underwent remimazolam TCI with the Schüttler model were reviewed. During anesthesia induction, the target Ce of remimazolam was gradually increased until loss of responsiveness, and it was titrated to maintain bispectral index of 40-70 during operation. Patients were categorized into young (20-40 years, n=24), middle-aged (41-60 years, n=27), and elderly (61-80 years, n=35) groups. Bispectral index and hemodynamic variables were also assessed.
The elderly group had significantly lower remimazolam Ce compared to the young and middle-aged groups at all sedation levels, intubation, and surgery. Mean highest intraoperative Ce was 0.78±0.10, 0.71±0.07, and 0.61±0.10 µg/mL in young, middle-aged, and elderly groups, respectively (<0.001). The recovery of responsiveness during emergence occurred at significantly lower Ce in the elderly group (0.28±0.06 µg/mL) than in the young (0.41±0.07 µg/mL) and middle-aged groups (0.35±0.07 µg/mL, <0.001). Ce during sedation and general anesthesia was comparable between the young and middle-aged groups. The bispectral index was similar across groups but fluctuated more in the elderly group during general anesthesia. Elderly patients also showed the greatest systolic blood pressure suppression (18.4 ± 13.29% before intubation and 34.31 ± 14.91% during surgery).
Older patients may require lower target Ce during remimazolam TCI for sedation and anesthesia, with emergence occurring at lower Ce. Blood pressure suppression may be greater in elderly patients under deep sedation or general anesthesia.
瑞马唑仑存在药代动力学和药效学（PKPD）模型，但靶控输注（TCI）的数据有限。Schüttler PKPD 模型是一个包括体重为协变量的三腔模型，不考虑年龄变量。本研究旨在通过使用 Schüttler PKPD 模型研究不同年龄组患者在镇静和全身麻醉期间 TCI 时瑞马唑仑效应部位浓度（Ce）。
回顾接受瑞马唑仑 TCI 且使用 Schüttler 模型的患者记录。在麻醉诱导期间，瑞马唑仑的目标 Ce 逐渐增加直至失去反应性，在手术期间将其滴定至双频谱指数维持在 40-70。将患者分为年轻组（20-40 岁，n=24）、中年组（41-60 岁，n=27）和老年组（61-80 岁，n=35）。还评估了双频谱指数和血液动力学变量。
在所有镇静水平、插管和手术中，老年组的瑞马唑仑 Ce 明显低于年轻组和中年组。术中最高 Ce 平均值分别为年轻、中年和老年组的 0.78±0.10、0.71±0.07 和 0.61±0.10µg/mL（<0.001）。在苏醒过程中，老年组的反应性恢复发生在 Ce 明显较低的情况下（0.28±0.06µg/mL），而年轻组（0.41±0.07µg/mL）和中年组（0.35±0.07µg/mL，<0.001）。在镇静和全身麻醉期间，年轻组和中年组之间的 Ce 相似，但老年组在全身麻醉期间波动更大。在全身麻醉期间，老年组的脑电双频指数相似，但波动较大。老年患者在深度镇静或全身麻醉下血压抑制也更大。
老年患者在接受瑞马唑仑 TCI 镇静和麻醉时可能需要较低的目标 Ce，并且在较低的 Ce 下出现苏醒。在深度镇静或全身麻醉下，老年患者的血压抑制可能更大。
