Yu Xuan, Xu Xinpeng, Wang Jing, Wang Zhao, Zhang Yi
Department of Anesthesiology, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, People's Republic of China.
Drug Des Devel Ther. 2025 May 30;19:4527-4535. doi: 10.2147/DDDT.S519732. eCollection 2025.
The choice of anesthetic drugs is crucial in ambulatory surgery. Esketamine has anesthetic, analgesic, and sedative effects, but it is associated with dose-dependent psychiatric symptoms. Benzodiazepines can alleviate these symptoms, but traditional drugs like midazolam may prolong the recovery time. Remimazolam tosilate as a novel benzodiazepine, has not been fully explored in terms of its effects when combined with esketamine and its impact on psychiatric symptoms.
A total of 249 patients undergoing elective laparoscopic surgery were enrolled. Randomly divided into the esketamine group (Group E), the esketamine plus midazolam group (Group EM), and the esketamine plus remimazolam tosilate group (Group ER). The primary outcome was the incidence of adverse reactions. The secondary outcomes included hemodynamics at different time points: at rest in the room (T0), immediately post-intubation (T1), immediately post-extubation (T2), 30 minutes following extubation (T3), and immediately after leaving the PACU (T4). Moreover, we also documented the Riker Sedation-Agitation Scale (SAS) scores at T2-4, as well as extubation time and PACU stay duration.
Patients in Group ER had a significantly lower incidence of postoperative diplopia and blurry vision compared to Groups E and EM (<0.05). Postoperative psychiatric symptoms were significantly lower in Groups EM and ER than in Group E (<0.05). At the T1 time point, Groups EM and ER displayed significantly lower MAP and HR, compared to Group E (<0.05). Groups E and ER displayed a shorter extubation time than Group EM (<0.05); the PACU stay of Group ER was shorter than those of Groups E and EM (<0.05). The SAS scores decreased from T2 to T4 in Groups EM and ER than in Group E (<0.05).
The combination of remimazolam tosilate and esketamine effectively reduces postoperative psychiatric symptoms, enhances hemodynamic stability, and improves recovery quality, making it a viable anesthetic strategy for ambulatory surgery.
麻醉药物的选择在门诊手术中至关重要。艾司氯胺酮具有麻醉、镇痛和镇静作用，但与剂量依赖性精神症状有关。苯二氮䓬类药物可缓解这些症状，但咪达唑仑等传统药物可能会延长恢复时间。作为一种新型苯二氮䓬类药物，甲苯磺酸瑞马唑仑与艾司氯胺酮联合使用时的效果及其对精神症状的影响尚未得到充分研究。
共纳入249例行择期腹腔镜手术的患者。随机分为艾司氯胺酮组（E组）、艾司氯胺酮加咪达唑仑组（EM组）和艾司氯胺酮加甲苯磺酸瑞马唑仑组（ER组）。主要结局是不良反应的发生率。次要结局包括不同时间点的血流动力学：在病房静息时（T0）、插管后即刻（T1）、拔管后即刻（T2）、拔管后30分钟（T3）以及离开麻醉后恢复室（PACU）后即刻（T4）。此外，我们还记录了T2至T4时间点的里克尔镇静 - 躁动量表（SAS）评分，以及拔管时间和PACU停留时间。
与E组和EM组相比，ER组患者术后复视和视力模糊的发生率显著更低（<0.05）。EM组和ER组术后精神症状显著低于E组（<0.05）。在T1时间点，与E组相比，EM组和ER组的平均动脉压（MAP）和心率（HR）显著更低（<0.05）。E组和ER组的拔管时间比EM组短（<0.05）；ER组在PACU的停留时间比E组和EM组短（<0.05）。与E组相比，EM组和ER组的SAS评分从T2到T4下降（<0.05）。
甲苯磺酸瑞马唑仑与艾司氯胺酮联合使用可有效降低术后精神症状，增强血流动力学稳定性，提高恢复质量，使其成为门诊手术可行的麻醉策略。
