Itaya Tomoaki, Takagi Shunichi, Sato Hanae, Kitajima Osamu, Doshu-Kajiura Akira, Matsui Miki, Yamamoto Mai, Yumoto Masatoshi, Suzuki Takahiro
Department of Anesthesiology, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
J Anesth. 2025 Apr 30. doi: 10.1007/s00540-025-03509-7.
Remimazolam is a new type of ultra-short-acting benzodiazepine. The aim of this study was to investigate the effects of remimazolam, propofol and sevoflurane anesthesia on rocuronium-induced neuromuscular block.
Ninety-nine consenting patients were randomly assigned to a remimazolam group (R-group), sevoflurane group (S-group), or propofol group (P-group). Train-of-four (TOF) responses evoked on the abductor digiti minimi muscle to ulnar nerve stimulation following bolus administration of 0.9-mg/kg rocuronium were monitored with electromyography-based neuromuscular monitor. The primary outcomes were times from administration of rocuronium to first reappearance of post-tetanic count (PTC). Free plasma concentrations of rocuronium were concurrently measured at these events.
Ninety patients were analyzed. No significant differences were seen in time to first PTC among the three groups. Mean (± standard deviation) and median (inter-quartile range) times for the reappearance of TOF counts 1 and 2 were significantly prolonged in S-group [50.7 ± 13.9 min, P = 0.043 and 61.6 (54.3-78.0) min, P = 0.020, respectively], when compared with P-group [42.6 ± 10.3 min and 52.9 (45.4-58.8) min, respectively]. However, no significant differences were seen between S-group and R-group. Median (inter-quartile range) free plasma concentration of rocuronium measured at first PTC was significantly lower in R-group [1255 (1126-1717) ng/mL] than in P-group [1717 (1592-1961) ng/mL, P = 0.031].
These results suggest that the potentiating effects of remimazolam on rocuronium-induced neuromuscular block are weaker than those of sevoflurane and similar to those of propofol.
瑞马唑仑是一种新型超短效苯二氮䓬类药物。本研究旨在探讨瑞马唑仑、丙泊酚和七氟醚麻醉对罗库溴铵诱导的神经肌肉阻滞的影响。
99例同意参与研究的患者被随机分为瑞马唑仑组（R组）、七氟醚组（S组）或丙泊酚组（P组）。静脉注射0.9mg/kg罗库溴铵后，使用基于肌电图的神经肌肉监测仪监测尺神经刺激引起的小指展肌的四个成串刺激（TOF）反应。主要观察指标为从注射罗库溴铵到强直刺激后计数（PTC）首次恢复的时间。在这些时间点同时测定罗库溴铵的血浆游离浓度。
对90例患者进行了分析。三组患者首次出现PTC的时间无显著差异。与P组[分别为42.6±10.3分钟和52.9（45.4 - 58.8）分钟]相比，S组中TOF计数1和2恢复的平均（±标准差）和中位数（四分位间距）时间显著延长[分别为50.7±13.9分钟，P = 0.043和61.6（54.3 - 78.0）分钟，P = 0.02]。然而，S组和R组之间无显著差异。R组在首次PTC时测定的罗库溴铵血浆游离浓度中位数（四分位间距）[1255（1126 - 1717）ng/mL]显著低于P组[1717（1592 - 1961）ng/mL，P = 0.031]。
这些结果表明，瑞马唑仑对罗库溴铵诱导的神经肌肉阻滞的增强作用弱于七氟醚，与丙泊酚相似。
