Anaesthetic efficacy and postinduction hypotension with remimazolam compared with propofol: a multicentre randomised controlled trial.

Remimazolam, a short-acting benzodiazepine, may be used for induction and maintenance of total intravenous anaesthesia, but its role in the management of patients with multiple comorbidities remains unclear. In this phase 3 randomised controlled trial, we compared the anaesthetic efficacy and the incidence of postinduction hypotension during total intravenous anaesthesia with remimazolam vs. propofol. A total of 365 patients (ASA physical status 3 or 4) scheduled for elective surgery were assigned randomly to receive total intravenous anaesthesia with remimazolam (n = 270) or propofol (n = 95). Primary outcome was anaesthetic effect, quantified as the percentage of time with Narcotrend® Index values ≤ 60, during surgery (skin incision to last skin suture), with a non-inferiority margin of -10%. Secondary outcome was the incidence of postinduction hypotensive events. Mean (SD) percentage of time with Narcotrend Index values ≤ 60 during surgery across all patients receiving remimazolam (93% (20.7)) was non-inferior to propofol (99% (4.2)), mean difference (97.5%CI) -6.28% (-8.89-infinite); p = 0.003. Mean (SD) number of postinduction hypotension events was 62 (38.1) and 71 (41.1) for patients allocated to the remimazolam and propofol groups, respectively; p = 0.015. Noradrenaline administration events (requirement for a bolus and/or infusion) were also lower in patients allocated to remimazolam compared with propofol (14 (13.5) vs. 20 (14.6), respectively; p < 0.001). In conclusion, in patients who were ASA physical status 3 or 4, the anaesthetic effect of remimazolam was non-inferior to propofol.

Effect of a moderate fish intake on platelet aggregation in human platelet-rich plasma.

This paper describes the results of an international study to investigate the effect of a reasonable amount of dietary fish on platelet aggregation in platelet-rich plasma (PRP) induced by collagen and thrombin. In Maastricht, Tromsø, and Zeist two groups of healthy male volunteers were given a daily dietary supplement consisting of 135 g of canned mackerel paste (experimental group, n = 40) or meat paste (control group, n = 42) for a 6-week period. Compliance, calculated on the basis of the urinary excretion of lithium, added to the supplements, was about 80%. Platelet number in PRP decreased significantly in the fish group. Collagen-induced platelet aggregation in PRP differed widely between the three centres despite the attempt to use exactly the same conditions. Nonetheless, aggregation decreased significantly in the fish group. The mackerel effect on thrombin-induced aggregation was inconsistent.

Physiological effects of fibre-rich types of bread. 1. The effect of dietary fibre from bread on the mineral balance of young men.

1. Twelve young adult male volunteers were given a low-fibre white bread diet (9 g neutral-detergent fibre (NDF)/d) and a medium-fibre coarse-bran bread diet (22 g NDF/d), each lasting 20 d. In ad third period of 20 d the volunteers were subdivided in groups of four, consuming a high-fibre coarse-bran bread diet (35 g NDF/d), a medium-fibre fine-bran bread diet (22 g NDF/d, bran particle size less than 0.35 mm) or a wholemeal bread diet (22 g NDF/d). Retention of calcium, magnesium, iron, zinc and copper were determined during each 20 d period. 2. An increase of the amount of dietary fibre (through bran) from 9 g to 22 g NDF/d resulted in a significantly increased mineral intake, but also faecal excretion increased significantly; mineral retention remained almost constant. 3. Both intake and faecal excretion of all minerals studied, except faecal Ca, increased further (P less than 0.05) on the diet providing 35 g NDF/d; only Fe balance decreased significantly. No significant differences with respect to intake, excretion (except urinary Ca) and balance of the minerals could be detected between the coarse-bran bread and fine-bran bread diets providing 22 g NDF/d. Faecal Fe, Cu balance and Mg balance increased significantly during the wholemeal bread period compared to the coarse-bran bread diet providing 22 g NDF. 4. Serum cholesterol increased significantly, i.e. by 0.3 mmol/l, during the coarse-bran bread diet providing 22 g NDF, compared to the white-bread diet. 5. It is concluded that increasing the amount of bran in bread does not appear to affect mineral balance considerably but there seems to be an influence on mineral availability. The increased intake was accompanied by increased faecal excretion.