Sedative effect of remimazolam for induction of general anesthesia in elderly patients / 中华麻醉学杂志

ABSTRACT

Objective:To evaluate the sedative effect of remimazolam for induction of general anesthesia in elderly patients.Methods:One hundred patients of both sexes, aged 65-75 yr, with American Society of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing elective general anesthesia requiring tracheal intubation, were divided into 4 groups ( n=25 each) using a random number table method: propofol group (group P) and three different doses of remimazolam groups (group R1, group R2 and group R3). In group P, general anesthesia was induced with propofol 1.5 mg/kg intravenously injected over 30 s, cisatracurium 0.2 mg/kg and fentanyl 4 μg/kg were intravenously injected when bispectral index (BIS) value ≤ 60, and endotracheal intubation was performed.In R1, R2 and R3 groups, general anesthesia was induced with 0.2, 0.3 and 0.4 mg/kg of remimazolam intravenously injected over 30 s, respectively, cisatracurium 0.2 mg/kg and fentanyl 4 μg/kg were intravenously injected when BIS value ≤ 60, and endotracheal intubation was performed.When the BIS value was > 60 during the induction of anesthesia, propofol 0.5 mg/kg was intravenously injected per time for rescue sedation in group P, and remimazolam 0.05 mg/kg was intravenously injected per time for rescue sedation until the BIS value ≤ 60, with the interval between the two injections > 1 min in R1, R2, and R3 groups.The onset time of propofol or remazolam was recorded.The occurrence of hypertension, hypotension, bradycardia, hypoxemia, injection pain and rescue sedation during the induction of anesthesia was recorded.The occurrence of intraoperative awareness was recorded during follow-up at 1 day after surgery. Results:Compared with group P, the rate of rescue sedation was significantly increased in group R1, the incidence of hypoxemia was significantly reduced in R1 and R2 groups, the onset time was significantly prolonged, and the incidence of hypotension, bradycardia and injection pain was decreased in R1, R2 and R3 groups ( P<0.05). Compared with group R1, the rate of rescue sedation was significantly decreased in R2 and R3 groups ( P<0.05). Compared with R1 and R2 groups, the incidence of hypoxemia was significantly increased in group R3 ( P<0.05). There was no significant difference in the incidence of hypotension, hypoxemia and injection pain among R1 group, R2 group and R3 group ( P>0.05). No hypertension and intraoperative awareness was found in the four groups. Conclusion:Remimazolam can be safely and effectively used for sedation during induction of general anesthesia in elderly patients, and the optimal dose is 0.3 mg/kg.