Cao Ying, Gan Mi, Wan Linling, Lu Jun, Liu Ting, Liu Meiyan, Wang Di, Hong Sen, Zhou Lin, Deng Luying, Wang Zijun, Wang Jingjie, Sun Changyu, Liu Yang, Liu Yanqiu, Zhou Meiwu
Department of Anesthesiology, The Second People's Hospital of Guiyang, The Affiliated Jinyang Hospital of Guizhou Medical University, Guiyang, People's Republic of China.
School of Anesthesiology, Guizhou Medical University, Guiyang, People's Republic of China.
Drug Des Devel Ther. 2025 Sep 3;19:7623-7636. doi: 10.2147/DDDT.S528483. eCollection 2025.
Remimazolam tosilate, a novel ultra-short-acting benzodiazepine, demonstrates promising safety profiles in clinical settings. While both remimazolam tosilate and etomidate provide hemodynamic stability during anesthesia induction, limited research has directly compared their effects on electroencephalogram (EEG) burst suppression (periods of transient brain wave silence), a potential predictor of adverse neurological outcomes. This study aims to compare the incidence rate of EEG burst suppression (ESR) with remimazolam tosilate versus etomidate by reviewing the drug regimens used by different anesthesiologists in clinical practice.
This single-center retrospective study analyzed clinical anesthesia induction data from 161 patients from October 2023 to July 2024. Patients received either remimazolam tosilate (0.2 mg/kg, n=86, Group R) or etomidate (0.3 mg/kg, n=75, Group E) for general anesthesia induction. Primary outcomes included ESR and its duration during induction. Second outcomes comprised hemodynamic parameters: systolic blood pressure, diastolic blood pressure mean arterial pressure, and heart rate, measured at baseline (T0), 3 minutes post-induction (T1), immediately after intubation (T2), 5 minutes post-intubation (T3), 10 minutes post-intubation (T4), and adverse events occurrence.
Baseline characteristics were comparable except ASA classification (higher ASA III proportion in Group R: 24.4% vs 2.7%, P<0.001). No ESR occurred in Group R versus 29.34% in Group E (P<0.01). Group R had a significantly lower incidence of intubation-related hypertension (10.5% vs 42.7%, P<0.001) and maintained stable blood pressure and HR throughout induction, whereas Group E exhibited marked MAP and HR fluctuations. Other adverse events showed no significant inter-group differences.
Remimazolam tosilate demonstrated notable differences compared to etomidate during general anesthesia induction, including the absence of ESR and different hemodynamic response patterns. While these findings suggest potential advantages for certain patient populations, the retrospective design and ASA classification imbalance limit definitive conclusions, warranting prospective validation studies.
新型超短效苯二氮䓬类药物甲苯磺酸瑞马唑仑在临床环境中显示出良好的安全性。虽然甲苯磺酸瑞马唑仑和依托咪酯在麻醉诱导期间均能提供血流动力学稳定性，但直接比较它们对脑电图（EEG）爆发抑制（短暂脑电波静息期）影响的研究有限，而EEG爆发抑制是不良神经学结局的一个潜在预测指标。本研究旨在通过回顾不同麻醉医生在临床实践中使用的药物方案，比较甲苯磺酸瑞马唑仑与依托咪酯的脑电图爆发抑制（ESR）发生率。
这项单中心回顾性研究分析了2023年10月至2024年7月期间161例患者的临床麻醉诱导数据。患者接受甲苯磺酸瑞马唑仑（0.2mg/kg，n = 86，R组）或依托咪酯（0.3mg/kg，n = 75，E组）进行全身麻醉诱导。主要结局包括诱导期间的ESR及其持续时间。次要结局包括血流动力学参数：在基线（T0）、诱导后3分钟（T1）、插管后即刻（T2）、插管后5分钟（T3）、插管后10分钟（T4）测量的收缩压、舒张压、平均动脉压和心率，以及不良事件的发生情况。
除美国麻醉医师协会（ASA）分级外，基线特征具有可比性（R组中ASA III级比例较高：24.4% 对2.7%，P < 0.001）。R组未发生ESR，而E组为29.34%（P < 0.01）。R组插管相关高血压的发生率显著较低（10.5% 对42.7%，P < 0.001），并且在整个诱导过程中血压和心率保持稳定，而E组的平均动脉压和心率出现明显波动。其他不良事件在组间无显著差异。
在全身麻醉诱导期间，甲苯磺酸瑞马唑仑与依托咪酯相比显示出显著差异，包括无ESR以及不同的血流动力学反应模式。虽然这些发现表明对某些患者群体可能具有潜在优势，但回顾性设计和ASA分级不平衡限制了确定性结论，需要进行前瞻性验证研究。
