Comparison of hemodynamics during induction of general anesthesia with remimazolam and target-controlled propofol in middle-aged and elderly patients: a single-center, randomized, controlled trial.
Comparison of hemodynamics during induction of general anesthesia with remimazolam and target-controlled propofol in middle-aged and elderly patients: a single-center, randomized, controlled trial.
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DOI：
10.1186/s12871-023-01974-9
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发表时间：
2023-01-10
影响因子：
2.2
通讯作者：
Tanaka, Katsuya
中科院分区：
文献类型：
--
作者：
Sekiguchi, Ryo;Kinoshita, Michiko;Kawanishi, Ryosuke;Kakuta, Nami;Sakai, Yoko;Tanaka, Katsuya
瑞马唑仑的低血压风险低于异丙酚。然而，尚无研究比较使用靶控输注 (TCI) 给药的瑞马唑仑和丙泊酚的疗效。本研究旨在探讨瑞马唑仑和靶控丙泊酚对中老年患者麻醉诱导过程中血流动力学的影响。 40 名年龄在 45-80 岁、美国麻醉医师协会身体状况为 1-2 级的成年人被随机分配到瑞马唑仑组或异丙酚组（每组 n=20）。患者接受瑞马唑仑（12 mg/kg/h）或异丙酚（3 μg/mL，TCI）以及瑞芬太尼诱导麻醉。我们记录血压、心率 (HR) 并使用脉搏波传播时间估计连续心输出量 (esCCO)。主要结果是诱导后平均动脉压（MAP）的最大变化。次要结果包括 HR、心输出量 (CO) 和每搏输出量 (SV) 的变化。两组麻醉诱导后 MAP 均下降，但组间无显着差异（瑞马唑仑组和丙泊酚组分别为− 41.1 [16.4] mmHg 和 − 42.8 [10.8] mmHg；平均差：1.7 [95% 置信区间： − 8.2 至 4.9]； p = 0.613).此外，两组诱导后 HR、CO 和 SV 均下降，但组间无显着差异。瑞马唑仑组直到意识丧失的时间明显短于异丙酚组（分别为 1.7 [0.7] 分钟和 3.5 [1.7] 分钟；p<<0.001）。然而，尽管调整了直到意识丧失的时间作为协变量，但两组之间的 MAP、HR、CO 和 SV 没有显着差异。瑞马唑仑组和丙泊酚组分别有 7 名 (35%) 和 11 名 (55%) 患者出现低血压（2.5 分钟内 MAP< 65 mmHg），组间无显着差异 (p = 0.341)。在麻醉诱导期间，瑞马唑仑组和靶控丙泊酚组之间的血流动力学没有显着差异。因此，麻醉药的选择、剂量和使用对于麻醉诱导时的血流动力学稳定性都很重要。临床医生应在使用瑞马唑仑和异丙酚诱导麻醉时监测低血压。 UMIN-CTR (UMIN000045612).
Remimazolam confers a lower risk of hypotension than propofol. However, no studies have compared the efficacy of remimazolam and propofol administered using target-controlled infusion (TCI). This study aimed to investigate hemodynamic effects of remimazolam and target-controlled propofol in middle-aged and elderly patients during the induction of anesthesia. Forty adults aged 45–80 years with the American Society of Anesthesiologists Physical Status 1–2 were randomly assigned to remimazolam or propofol group (n = 20 each). Patients received either remimazolam (12 mg/kg/h) or propofol (3 μg/mL, TCI), along with remifentanil for inducing anesthesia. We recorded the blood pressure, heart rate (HR), and estimated continuous cardiac output (esCCO) using the pulse wave transit time. The primary outcome was the maximum change in mean arterial pressure (MAP) after induction. Secondary outcomes included changes in HR, cardiac output (CO), and stroke volume (SV). MAP decreased after induction of anesthesia in both groups, without significant differences between the groups (− 41.1 [16.4] mmHg and − 42.8 [10.8] mmHg in remimazolam and propofol groups, respectively; mean difference: 1.7 [95% confidence interval: − 8.2 to 4.9]; p = 0.613). Furthermore, HR, CO, and SV decreased after induction in both groups, without significant differences between the groups. Remimazolam group had significantly shorter time until loss of consciousness than propofol group (1.7 [0.7] min and 3.5 [1.7] min, respectively; p < 0.001). However, MAP, HR, CO, and SV were not significantly different between the groups despite adjusting time until loss of consciousness as a covariate. Seven (35%) and 11 (55%) patients in the remimazolam and propofol groups, respectively, experienced hypotension (MAP < 65 mmHg over 2.5 min), without significant differences between the groups (p = 0.341). Hemodynamics were not significantly different between remimazolam and target-controlled propofol groups during induction of anesthesia. Thus, not only the choice but also the dose and usage of anesthetics are important for hemodynamic stability while inducing anesthesia. Clinicians should monitor hypotension while inducing anesthesia with remimazolam as well as propofol. UMIN-CTR (UMIN000045612).
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影响因子：
2.8
作者：
Doi, Matsuyuki;Morita, Kiyoshi;Suzuki, Toshiyasu
通讯作者：
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