Kawasaki Takashi, Fujimoto Masafumi, Hirata Naoyuki
Department of Anesthesiology, Kumamoto University Hospital, 1-1-1, Honjyo, Cyuoku, Kumamoto-City, Kumamoto, 860-8556, Japan.
Department of Anesthesiology, Kumamoto University School of Medical Sciences, Kumamoto University Hospital, 1-1-1, Honjyo, Cyuoku, Kumamoto-City, Kumamoto, 860-8556, Japan.
J Anesth. 2025 May 26. doi: 10.1007/s00540-025-03517-7.
The anesthetic management combining remimazolam and neuromuscular blocking agents with sugammadex is expected to enhance the speed and safety of recovery from anesthesia. However, the effect of remimazolam on reversal of neuromuscular blockade with sugammadex remains unclear. We hypothesized that sugammadex could reverse rocuronium-induced neuromuscular blockade even under remimazolam anesthesia, although the recovery might be delayed. In the present study, the recovery time from rocuronium-induced neuromuscular blockade after administration of sugammadex under remimazolam anesthesia was compared with that under propofol anesthesia.
Twenty-six patients over 18 years old scheduled for elective gynecological laparotomy under general anesthesia combined with epidural anesthesia were prospectively randomly assigned to remimazolam and propofol groups. After induction of general anesthesia with remifentanil and remimazolam or remifentanil and propofol, followed by their continuous infusion for anesthesia maintenance, train-of-four (TOF) responses were monitored following 0.9 mg/kg rocuronium administration. During surgery, rocuronium was infused continuously to maintain a TOF count of 1. At the end of surgery, when TOF counts of 2 were confirmed, sugammadex 2 mg/kg was administered and time to recovery of the TOF ratio to ≥ 90% of the baseline TOF ratio was compared between the two groups.
Median (interquartile range) recovery times in the remimazolam and propofol groups were 3.0 (2.3 to 3.8) and 2.5 (2.0 to 3.3) min, respectively (P = 0.62).
Remimazolam anesthesia may not delay the efficacy of sugammadex in reversing rocuronium-induced neuromuscular blockade compared with propofol anesthesia.
The Japan Registry of Clinical trials (jRCT1071230073). URL: https://jrct.niph.go.jp/latest-detail/jRCT1071230073 .
将瑞米唑仑与神经肌肉阻滞剂及舒更葡糖钠联合用于麻醉管理，有望提高麻醉恢复的速度和安全性。然而，瑞米唑仑对舒更葡糖钠逆转神经肌肉阻滞的作用尚不清楚。我们推测，即使在瑞米唑仑麻醉下，舒更葡糖钠也能逆转罗库溴铵诱导的神经肌肉阻滞，尽管恢复可能会延迟。在本研究中，比较了瑞米唑仑麻醉下给予舒更葡糖钠后罗库溴铵诱导的神经肌肉阻滞的恢复时间与丙泊酚麻醉下的恢复时间。
26例年龄超过18岁、计划在全身麻醉联合硬膜外麻醉下行择期妇科剖腹手术的患者，前瞻性随机分为瑞米唑仑组和丙泊酚组。在分别用瑞芬太尼和瑞米唑仑或瑞芬太尼和丙泊酚诱导全身麻醉，随后持续输注以维持麻醉后，给予0.9mg/kg罗库溴铵后监测四个成串刺激（TOF）反应。手术期间，持续输注罗库溴铵以维持TOF计数为1。手术结束时，确认TOF计数为2后，给予2mg/kg舒更葡糖钠，并比较两组TOF比值恢复至基线TOF比值≥90%的时间。
瑞米唑仑组和丙泊酚组的中位（四分位间距）恢复时间分别为3.0（2.3至3.8）分钟和2.5（2.0至3.3）分钟（P = 0.62）。
与丙泊酚麻醉相比，瑞米唑仑麻醉可能不会延迟舒更葡糖钠逆转罗库溴铵诱导的神经肌肉阻滞的效果。
日本临床试验注册中心（jRCT1071230073）。网址：https://jrct.niph.go.jp/latest-detail/jRCT1071230073 。
