Effect of remazolam combined with remifentanil on intraoperative circulatory function and PONV in elderly patients taking ophthalmic general anesthesia

doi:10.3760/cma.j.issn.1007-1245.2023.06.017

Abstract

Abstract:

Objective　To explore the effect of remazolam combined with remifentanil on intraoperative circulatory function and postoperative nausea and vomiting (PONV) in elderly patients taking ophthalmic general anesthesia. Methods　Ninety-four elderly patients undergoing general anesthesia surgery in Ophthalmic Operating Room, Jinan Second People's Hospital from April 2021 to July 2022 were randomly divided into a control group and a study group, with 47 cases in each group. There were 27 males and 20 females in the control group; they were (67.89±7.58) years old. There were 25 males and 22 females in the study group; they were (68.18±7.82) years old. The control group were given propofol 0.6-1.2 mg/kg for anesthesia induction and 4-10 mg•kg^-1•h^-1 for maintenance. The study group were given remazolam 0.1-0.3 mg/kg for anesthesia induction and remazolam 0.8-1.2 mg•kg^-1•h^-1 and remifentanil 0.1-0.2 μg•kg^-1•min^-1 for maintenance. The cardiac indexes (CI) and cardiac outputs (CO), mean artery pressures (MAP), and oxygen saturations (SpO₂) were compared between the two groups before anesthesia induction (T₀), when anesthesia induction succeeded (T₁), immediately after laryngeal mask placement (T₂), and 20 minutes after surgery (T₃). The rates and severities of postoperative nausea (PON), postoperative vomiting (POV), and postoperative nausea and vomiting (PONV) were compared between the two groups. The anesthesia recovery indicators (awakening time, extubation time, and restlessness during recovery) were compared between the two groups. The χ², t, and Mann-Whitney U tests were applied. Results　The CI's at T₁, T₂, and T₃ in the study group were higher than those in the control group [(2.89±0.43) min•m^-2 vs. (2.64±0.41) min•m^-2, (2.71±0.37) min•m^-2 vs. (2.54±0.33) min•m^-2, and (2.85±0.40) min•m^-2 vs. (2.60±0.38) min•m^-2]. The CO's at T₁, T₂, and T₃ in the study group were higher than those in the control group [(5.26±0.47) L/min vs. (4.92±0.43) L/min, (4.72±0.41) L/min vs. (4.46±0.38) L/min, and (5.10±0.45) L/min vs. (4.78±0.40) L/min]. The MAP at T₂ in the study group was higher than that in the control group [(75.50±6.73) mmHg vs. (72.14±6.25) mmHg,t=2.508,P<0.05]. The SpO₂ at T₂ and T₃ in the study group were higher than those in the control group, with statistical differences (t=2.699 and 2.209; both P<0.05). The incidences of PON, POV, and PONV within 48 h after the operation in the study group were lower than those in the control group (χ²=4.065, 4.821, and 5.317; all P<0.05). The severity scores of PON and POV 6 h after the surgery in the study group were lower than those in the control group (Z=2.403 and 2.354; both P<0.05). The severity scores of PON and POV 12 h after surgery in the study group were lower than those in the control group (Z=2.136 and 2.081; both P<0.05). The awakening time and extubation time in the study group were lower than those in the control group [(20.40±3.98) min vs. (13.62±2.84) min and (23.25±4.15) min vs. (15.17±3.32) min; t=8.922 and 10.423, both P<0.001]. Conclusions　Compared with propofol anesthesia induction and maintenance, the application of remazolam and remifentanil in elderly patients taking ophthalmic general anesthesia has relatively stable intraoperative CI, CO, MAP, and SpO₂, and the incidence and severity of PONV are lower. The disadvantage is that the recovery time and extubation time are relatively long.

Key words:

Remazolam, Remifentanil, Geriatric anesthesia, Ophthalmic surgery, Circulatory function, Postoperative nausea and vomiting

摘要：

目的　探讨瑞马唑仑联合瑞芬太尼对老年眼科全麻患者术中循环功能和术后恶心呕吐（PONV）的影响。方法　将济南市第二人民医院2021年4月至2022年7月接收的老年全麻手术患者94例进行随机对照试验，随机分为对照组与研究组，每组各47例。对照组男27例，女20例，年龄（67.89±7.58）岁，给予丙泊酚0.6～1.2 mg/kg麻醉诱导及4～10 mg·kg^-1·h^-1维持；研究组男25例，女22例，年龄（68.18±7.82）岁，采用瑞马唑仑0.1～0.3 mg/kg麻醉诱导，给予瑞马唑仑0.8～1.2 mg·kg^-1·h^-1，瑞芬太尼0.1～0.2 μg·kg^-1·min^-1维持麻醉。比较两组患者麻醉诱导前（T₀）、麻醉诱导成功（T₁）、喉罩置入即刻（T₂）、手术20 min（T₃）监测患者的心脏指数（CI）、心输出量（CO）、平均动脉压（MAP）及血氧饱和度（SpO₂）；比较两组患者术后恶心（PON）、术后呕吐（POV）、PONV发生率及严重程度；对比两组患者麻醉苏醒指标（清醒时间、拔管时间与苏醒期间躁动）。统计学方法采用χ²检验、t检验、Mann-Whitney U检验。结果　研究组T₁、T₂、T₃的CI均高于对照组同期［（2.89±0.43）min•m^-2比（2.64±0.41）min•m^-2、（2.71±0.37）min•m^-2比（2.54±0.33）min•m^-2、（2.85±0.40）min•m^-2比（2.60±0.38）min•m^-2］；研究组T₁、T₂、T₃的 CO均高于对照组同期［（5.26±0.47）L/min比（4.92±0.43）L/min、（4.72±0.41）L/min比（4.46±0.38）L/min、（5.10±0.45）L/min比（4.78±0.40）L/min］；研究组T₂的MAP高于对照组同期［（75.50±6.73）mmHg比（72.14±6.25）mmHg，t=2.508，P<0.05］；研究组T₂、T₃的SpO₂均高于对照组同期，差异均有统计学意义（t=2.699、2.209，均P<0.05）；研究组术后48 h内PON、POV及PONV发生率均低于对照组（χ²=4.065、4.821、5.317，均P<0.05）；研究组术后6 h的PON及POV严重程度评分均低于对照组同期（Z=2.403、2.354，均P<0.05）；研究组术后12 h的PON及POV严重程度评分均低于对照组同期（Z=2.136、2.081，均P<0.05）；研究组清醒时间、拔管时间均长于对照组［（20.40±3.98）min比（13.62±2.84）min，（23.25±4.15）min比（15.17±3.32）min，t=8.922、10.423，均P<0.05）］。结论　与丙泊酚麻醉诱导与维持比较，瑞马唑仑联合瑞芬太尼应用老年眼科全麻手术患者，术中CI、CO、MAP、SpO₂相对平稳，PONV发生率及严重程度更低，不足之处是苏醒时间与拔管时间相对较长。

关键词:

瑞马唑仑, 瑞芬太尼, 老年麻醉, 眼科手术, 循环功能, 术后恶心呕吐

Zhao Qing, Wu Xiandeng, Wu Peng.

Effect of remazolam combined with remifentanil on intraoperative circulatory function and PONV in elderly patients taking ophthalmic general anesthesia [J]. International Medicine and Health Guidance News, 2023, 29(6): 823-828.

赵晴吴宪登武鹏.

瑞马唑仑联合瑞芬太尼对老年眼科全麻患者术中循环功能及PONV的影响 [J]. 国际医药卫生导报, 2023, 29(6): 823-828.

References

[1] 张辉,刘德成,王益敏,等.基于麻醉与围术期医学专科数据平台的术后急性中重度疼痛风险因素分析[J].实用医学杂志,2021,37(15):1958-1962.DOI:10.3969/j.issn.1006- 5725. 2021.15.010.
[2] 张广琦,葛俊峰.丙泊酚联合去氧肾上腺素诱导在眼科全麻手术中对血流动力学的影响[J].国际医药卫生导报,2022,28(16):2339-2342.DOI:10.3760/cma.j.issn.1007-1245. 2022.16.028.
[3] 王若菡,李冰,袁景丽,等.胸科手术病人术后恶心呕吐的危险因素[J].中华麻醉学杂志,2022,42(2):143-146.DOI:10.3760/cma.j.cn131073.20210911.00204.
[4] Rajan N,Joshi GP.Management of postoperative nausea and vomiting in adults: current controversies[J].Curr Opin Anaesthesiol,2021,34(6):695-702.DOI:10.1097/ACO.0000000000001063.
[5] 马俊丽,魏新川.术后恶心呕吐病因、机制和治疗进展[J].实用医院临床杂志,2022,19(1):190-193.DOI:10.3969/j.issn.1672-6170.2022.01.052.
[6] 张云云,汪小海,艾尼·买买提明,等.丙泊酚与依托咪酯对全麻诱导后低血压发生率的影响分析[J].药学与临床研究,2021,29(1):31-34,80.DOI:10.13664/j.cnki.pcr.2021. 01.008.
[7] 奚曼,王爽,陈妍,等.甲强龙联合托烷司琼对妇科日间手术全身麻醉患者术后恶心呕吐的预防作用[J].中国医科大学学报,2021,50(2):160-164.DOI:10.12007/j.issn.0258-4646.2021.02.013.
[8] Apfelbaum JL,Hagberg CA,Connis RT,et al.2022 American society of anesthesiologists practice guidelines for management of the difficult airway[J].Anesthesiology,2022,136(1):31-81.DOI:10.1097/ALN. 0000000000004002.
[9] Massoth C,Schwellenbach J,Saadat-Gilani K,et al.Impact of opioid-free anaesthesia on postoperative nausea, vomiting and pain after gynaecological laparoscopy - a randomised controlled trial[J].J Clin Anesth,2021,75:110437.DOI:10.1016/j.jclinane.2021.110437.
[10] 余婉秋,李禹琼,朱圣姬,等.苯磺酸瑞马唑仑与丙泊酚用于无痛结肠镜检查的有效性及安全性的随机、单盲、平行对照研究[J].贵州医药,2020,44(6):846-849,后插1.DOI:10.3969/j.issn.1000-744X.2020.06.002.
[11] Doi M,Morita K,Takeda J,et al. Efficacy and safety of remimazolam versus propofol for general anesthesia: a multicenter, single-blind, randomized, parallel-group, phase IIb/III trial[J].J Anesth,2020,34(4):543-553.DOI:10.1007/s00540-020-02788-6.
[12] 李会新,邢飞,张卫,等.瑞马唑仑和丙泊酚对目标导向血流动力学管理策略老年患者术后恢复质量影响的比较[J].中华麻醉学杂志,2021,41(12):1433-1436.DOI:10.3760/cma.j.cn131073.20210902.01206.
[13] 段声吉,冉鑫,张杰,等.瑞马唑仑对麻醉诱导期脑电双频指数及血流动力学的影响[J].国际麻醉学与复苏杂志,2022,43(7):682-685.DOI:10.3760/cma.j.cn321761-20211121- 00581.
[14] Stöhr T,Colin PJ,Ossig J,et al.Pharmacokinetic properties of remimazolam in subjects with hepatic or renal impairment[J].Br J Anaesth,2021,127(3):415-423.DOI:10.1016/j.bja.2021.05.027.
[15] 康佳敏,元元,于泳浩,等.瑞马唑仑临床研究进展[J].中华麻醉学杂志,2022,42(8):1020-1024.DOI:10.3760/cma.j.cn131073.20220321.00828.
[16] 李锦玉,罗静雅,汪俊恺,等.瑞马唑仑用于高龄患者麻醉诱导期镇静的药效学[J].中华麻醉学杂志,2022,42(8):996-997.DOI:10.3760/cma.j.cn131073.20220419.00822.
[17] 李文瑶,陶国才,牛洋,等.瑞马唑仑联合氟马西尼在老年患者胃镜检查中的应用[J].实用医院临床杂志,2021,18(4):89-91.DOI:10.3969/j.issn.1672-6170.2021.04.026.
[18] Veiga-Gil L,Pueyo J,López-Olaondo L.Postoperative nausea and vomiting: physiopathology, risk factors, prophylaxis and treatment[J].Rev Esp Anestesiol Reanim,2017,64(4):223-232.DOI:10.1016/j.redar.2016.10.001.
[19] Kovac AL.Postoperative nausea and vomiting in pediatric patients[J].Paediatr Drugs,2021,23(1):11-37.DOI:10.1007/s40272-020-00424-0.
[20] Sato S,Doi M,Morita K,et al.Remimazolam a new ultra-short actinganesthetic shows similar efficacy and superior hemodynamic stability vs propofol in general[C].Chicago,USA:Poster Session Presented at the ANESTHESOLOGY 2015 Annual Meeting,2015.
[21] Chen S,Wang J,Xu X,et al.The efficacy and safety of remimazolam tosylate versus propofol in patients undergoing colonoscopy: a multicentered, randomized, positive-controlled, phase III clinical trial[J]. Am J Transl Res,2020,12(8):4594-4603.