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

Sekiguchi, Ryo; Kinoshita, Michiko; Kawanishi, Ryosuke; Kakuta, Nami; Sakai, Yoko; Tanaka, Katsuya

doi:10.1186/s12871-023-01974-9

Cited by 16 publications

(14 citation statements)

References 37 publications

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“…On the other hand, in another study comparing remimazolam and propofol, it was reported that there were no differences in hemodynamic indices, including MAP [ 21 ]. The authors speculated that the inconsistency with other studies may be attributed to differences in the administered drug regimen [ 21 ]. Similarly, in our study, the possibility of disparities arising from the drug regimen cannot be excluded.…”

Section: Discussionmentioning

confidence: 99%

Effect of Remimazolam- versus Propofol-Based Total Intravenous General Anesthesia on Intraoperative Hemodynamic Stability for Major Spine Surgery in the Prone Position: A Randomized Controlled Trial

Kim,

Park

et al. 2024

Medicina

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Background and Objectives: Remimazolam offers advantages over propofol in terms of hemodynamic stability. However, it remains unclear whether remimazolam-based total intravenous anesthesia (TIVA) can reduce intraoperative hypotension compared to propofol-based TIVA, especially after prone positioning. In this study, we compared the effects of remimazolam- and propofol-based TIVA on intraoperative hemodynamic stability in patients undergoing surgery in the prone position. Materials and Methods: This study randomly assigned patients undergoing major spinal surgery in the prone position to the propofol or remimazolam group. Target-controlled infusion (2–3.5 μg/mL for induction and 2–3 μg/mL for maintenance) was used in the propofol group and continuous infusion (6 mg/kg/h for induction and 1–2 mg/kg/h for maintenance) was used in the remimazolam group; target-controlled infusion (3–5 ng/mL) of remifentanil was performed in both groups. The primary outcomes were the incidence of hypotensive episodes during the first hour after prone positioning. The secondary outcomes included the incidence of severe hypotension and the total amount of inotropic or vasopressor medication. Systolic and mean arterial pressure, heart rate, cardiac index and output, stroke volume, stroke volume variation, and pleth variability index were also evaluated. These variables were recorded per minute for the first 10 min after prone positioning, and every 10 min thereafter. Results: The study enrolled 94 patients (47 patients in each group). The incidence of hypotension or severe hypotension did not differ significantly between the two groups during the first hour after prone positioning. The total amount of ephedrine administered during the first hour after prone positioning was lesser (p = 0.020) and the mean arterial pressure during the initial 10 min after prone positioning was higher in the remimazolam group (p = 0.003). Conclusions: Our study uncovered no significant differences in the incidence of hypotension between remimazolam- and propofol-based TIVA in patients undergoing major spine surgery in prone position.

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Section: Discussionmentioning

confidence: 99%

Effect of Remimazolam- versus Propofol-Based Total Intravenous General Anesthesia on Intraoperative Hemodynamic Stability for Major Spine Surgery in the Prone Position: A Randomized Controlled Trial

Kim,

Park

et al. 2024

Medicina

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“…In a previous study, the time to extubation after cessation of remimazolam decreased to a value comparable to that after sevoflurane cessation. [20] There was a previous study by Sekiguchi et al [21] comparing remimazolam and propofol during the induction of anesthesia in middle-aged and elderly patients, and no significant difference of hemodynamics were observed between those who administered remimazolam and propofol. There are several difference between the study by Sekiguchi et al and this study.…”

Section: Discussionmentioning

confidence: 99%

Incidence of intraoperative hypotension in older patients undergoing total intravenous anesthesia by remimazolam versus propofol: A randomized controlled trial

Jeon,

Kim,

Park

et al. 2023

Medicine

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Background: An increase in the frequency of surgeries among older individuals is observed in some countries. Hypotension is common and exaggerated in older patients and can lead to increased morbidity and mortality. Total intravenous anesthesia is commonly administered with propofol, while remimazolam has been suggested as an alternative to propofol because of advantages such as a more stable hemodynamic profile and less respiratory suppression. We conducted a single-blind, parallel-group randomized controlled trial to compare the incidence of intraoperative hypotension between patients administered with remimazolam and propofol. Methods: A total of 132 patients, aged between 65 to 80 years and undergoing laparoscopic cholecystectomy or transurethral resection of bladder tumors were randomly assigned to the propofol or remimazolam group with a permuted block system while being blinded to the hypnotic agent. Remifentanil was administered via target-controlled infusion in both groups, with an initial effect-site concentration of 3.0 ng/mL and titration range of 1.5 to 4.0 ng/mL intraoperatively. The primary outcome of this study was the overall incidence of hypotension during general anesthesia. Results: Patients in the propofol group experienced higher intraoperative hypotension than those in the remimazolam group (59.7% vs 33.3%, P = .006). Multivariate logistic regression analysis showed that remimazolam administration was associated with reduced hypotension (adjusted odds ratio, 0.34; 95% CI, 0.16–0.73). Secondary outcomes such as recovery time, delirium, and postoperative nausea and vomiting were comparable in both groups. Conclusion: Total intravenous anesthesia with remimazolam was associated with less intraoperative hypotension than propofol in older patients, with a comparable recovery profile.

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“…If propofol is used alone, 35% of patients experience one or more hypotensions during colonoscopy ( 3 ). Moreover, studies have demonstrated that 55% of patients who received 3 μg/ml of propofol via target-controlled infusion (TCI) experienced hypotension ( 27 ). Our results revealed that the incidence of hypotension in both groups was 28 and 17.2%, respectively.…”

Section: Discussionmentioning

confidence: 99%

The median effective dose of propofol combined with butorphanol during artificial abortion: a randomized controlled trial

Zheng,

Huang,

Mai

et al. 2023

Front. Med.

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ObjectivePropofol-opioids are the most common drug combination and can reduce the dose of propofol and the incidence of adverse events in painless artificial abortion. We hypothesized that butorphanol may reduce the median effective dose (ED50) of propofol, propofol injection pain, and postoperative uterine contraction pain.MethodsThis was a randomized, double-blind, controlled study. A total of 54 female patients, who had ASA I or II, aged 18–49 years, undergoing painless artificial abortion, were randomly assigned into two groups, namely, Group P (propofol) and Group PB (propofol plus 10 μg/kg butorphanol). According to the pre-experiment, the initial dose of propofol for the P and PB groups was 3 and 2.5 mg/kg, respectively, with a dose gradient of 0.25 mg/kg. The ED50 of propofol was analyzed using probit regression analysis. The total propofol dose consumed, recovery time, and anesthesia-related adverse events were also recorded.ResultsThere were 25 and 29 patients in the P and PB groups, respectively. The ED50 (95% CI) of propofol for artificial abortion were 2.477 (2.186–2.737) and 1.555 (1.173–1.846) mg/kg in the P and PB groups, respectively. The total propofol dose consumed was (150.7 ± 21.7) mg and (110.4 ± 28.2) mg in the P and PB groups, respectively (P < 0.001). Compared with the P group, injection-site pain (76 vs. 20.7%) and uterine contraction pain (72 vs. 6.9%) in the PB group had a significant decrease (P < 0.001).ConclusionCombination of propofol with 10 μg/kg butorphanol reduced the ED50 of propofol and decreased the incidence of propofol injection-site pain and postoperative uterine contraction pain during painless artificial abortion compared with propofol alone.Clinical trial registrationhttps://www.chictr.org.cn/showproj.html?proj=166610, identifier: ChiCTR2200059795.

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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

Cited by 16 publications

References 37 publications

Effect of Remimazolam- versus Propofol-Based Total Intravenous General Anesthesia on Intraoperative Hemodynamic Stability for Major Spine Surgery in the Prone Position: A Randomized Controlled Trial

Effect of Remimazolam- versus Propofol-Based Total Intravenous General Anesthesia on Intraoperative Hemodynamic Stability for Major Spine Surgery in the Prone Position: A Randomized Controlled Trial

Incidence of intraoperative hypotension in older patients undergoing total intravenous anesthesia by remimazolam versus propofol: A randomized controlled trial

The median effective dose of propofol combined with butorphanol during artificial abortion: a randomized controlled trial

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