Kim Bo Rim, Kim Hye-Bin, Kim Moo Soo, Lim Byung Gun, Oh Seok Kyeong
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Republic of Korea.
J Clin Med. 2025 Aug 4;14(15):5491. doi: 10.3390/jcm14155491.
Total intravenous anesthesia (TIVA) typically combines propofol and remifentanil. Remifentanil exerts minimal influence on motor evoked potential (MEP), whereas propofol partially reduces MEP amplitude. Remimazolam, a novel agent, is a component of TIVA. However, evidence of remimazolam on MEP is limited. We aimed to compare the effects of propofol and remimazolam, combined with remifentanil, on relative MEP depression. Using a crossover design, 18 patients undergoing spine surgery were randomly assigned to receive either propofol or remimazolam as the first agent. In the propofol first sequence, anesthesia was induced and maintained with propofol, which was then switched to remimazolam 60 min after surgery. In the remimazolam first sequence, remimazolam was used first and then switched to propofol. The primary outcomes measured were the MEP amplitude and latency. MEP amplitude and latency during propofol and remimazolam infusions were as follows: amplitude (mean (SD); 635.3 (399.1) vs. 738.4 (480.4) μV, = 0.047) and latency (median [IQR]; 22.4 [20.3-24.6] vs. 21.4 [19.6-23.5] ms, = 0.070), indicating propofol caused greater depression in amplitude than remimazolam. However, an incident of severe body movement disrupting surgery occurred under remimazolam anesthesia in a young, healthy male patient, although bispectral index remained below 60. This suggests that remimazolam, at hypnotic levels similar to propofol, may result in reduced akinesia in major surgeries, such as spinal surgery, when neuromuscular blockade is not employed. Remimazolam demonstrated comparable or superior effects to propofol on MEP latency and amplitude when combined with remifentanil during spinal surgery, rendering it a potential alternative to propofol for MEP monitoring.
全静脉麻醉（TIVA）通常联合使用丙泊酚和瑞芬太尼。瑞芬太尼对运动诱发电位（MEP）影响极小，而丙泊酚会部分降低MEP波幅。新型药物瑞马唑仑是TIVA的组成部分。然而，关于瑞马唑仑对MEP影响的证据有限。我们旨在比较丙泊酚和瑞马唑仑联合瑞芬太尼对相对MEP抑制的影响。采用交叉设计，将18例接受脊柱手术的患者随机分为两组，分别先给予丙泊酚或瑞马唑仑。在丙泊酚优先顺序组中，先用丙泊酚诱导并维持麻醉，术后60分钟后换用瑞马唑仑。在瑞马唑仑优先顺序组中，先使用瑞马唑仑，然后换用丙泊酚。主要测量指标为MEP波幅和潜伏期。丙泊酚和瑞马唑仑输注期间的MEP波幅和潜伏期如下：波幅（均值（标准差）；635.3（399.1）μV对738.4（480.4）μV，P = 0.047）和潜伏期（中位数[四分位间距]；22.4[20.3 - 24.6]毫秒对21.4[19.6 - 23.5]毫秒，P = 0.070），表明丙泊酚引起的波幅抑制比瑞马唑仑更大。然而，在一名年轻健康男性患者的瑞马唑仑麻醉下发生了严重身体移动干扰手术的事件，尽管脑电双频指数仍低于60。这表明，在不使用神经肌肉阻滞的情况下，与丙泊酚催眠水平相似时，瑞马唑仑在脊柱手术等大手术中可能导致运动不能减少。在脊柱手术期间，瑞马唑仑与瑞芬太尼联合使用时，在MEP潜伏期和波幅方面显示出与丙泊酚相当或更好的效果，使其成为丙泊酚用于MEP监测的潜在替代药物。
