Quality of Recovery After General Anesthesia with Remimazolam in Patients’ Undergoing Urologic Surgery: A Randomized Controlled Trial Comparing Remimazolam with Propofol

Mao, Yuan-Yuan; Guo, Jin; Yuan, Jing; Zhao, Erxian; Yang, Jian-Guang

doi:10.2147/dddt.s359496

Cited by 45 publications

(33 citation statements)

References 41 publications

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“…An exploratory analysis suggested more episodes of hypotension when propofol was used for sedation than remimazolam [ 36 ]. Furthermore, a series of studies have shown that remimazolam had more stable hemodynamics and a lower incidence of hypotension in multiple surgical types [ 34 , 37 – 41 ]. In our study, the incidence of hypotension was lower and a higher average MAP existed in AR groups than AP group.…”

Section: Discussionmentioning

confidence: 99%

Sedative effect of remimazolam combined with alfentanil in colonoscopic polypectomy: a prospective, randomized, controlled clinical trial

et al. 2022

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Background Remimazolam is a newer benzodiazepine with properties of rapid onset, short duration of action, and fast recovery. Our study was to evaluate the effects of different doses of remimazolam combined with alfentanil in colonoscopic polypectomy. Methods One hundred twenty patients were randomly divided into four groups: alfentanil and propofol (AP) group, alfentanil and remimazolam 0.1 mg/kg (AR1 group), 0.15 mg/kg (AR2 group), or 0.2 mg/kg (AR3 group). Patients in the four groups received alfentanil 10 μg/kg, followed by propofol 2 mg/kg and three dosages of remimazolam. Modified Observer's Assessment of Alertness and Sedation (MOAA/S) scale, heart rate (HR), oxygen saturation (SpO2), respiratory rate (RR), bispectral index (BIS) values and mean arterial pressure (MAP) were collected at intervals of 5 min and analyzed at different time points: before anesthesia (T0), 5 min (T1), 10 min (T2), 15 min after anesthesia (T3) and at the end of surgery (T4). The average MAP was calculated utilizing the average of all MAP values. The primary outcome was the success rate of sedation. Secondary outcomes included time to full alert and adverse events. Results The success rate of sedation was 100% among the four groups. The incidence of hypotension was significantly decreased (all P < 0.05) and the average MAP was higher in AR1-AR3 groups than AP group (all P < 0.001). None of the patients developed bradycardia or hypertension during surgery in all study groups. BIS values were higher (all P < 0.001) and the time to full alert was statistically shorter in AR1-AR3 groups (all P < 0.05) compared with the AP group. The MOAA/S score in AR1 was higher than AR2 (P < 0.05) and the AR3 group (P < 0.05) at T1 and BIS values in the AR1 group were significantly higher than AR3 group (P < 0.05) at T4. Conclusions Remimazolam combined with alfentanil have a non-inferior sedative effect than propofol during the colonoscopic polypectomy. Moreover, this combination of two short-acting drugs might be a safer alternative. Trial registration The clinical trial was registered on (16/05/2021, ChiCTR2100046492).

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Section: Discussionmentioning

confidence: 99%

Sedative effect of remimazolam combined with alfentanil in colonoscopic polypectomy: a prospective, randomized, controlled clinical trial

et al. 2022

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“…[37][38][39] Our results showed that, compared with propofol, remimazolam had a lower incidence of hypotension and less dose of the intraoperative vasoactive drug, which was consistent with previous reports. 40 Notably, hypotension is often associated with poor outcomes, especially in older adults with multiple comorbidities, which may contribute to perioperative cognitive decline. 41 The stable hemodynamic properties of remimazolam may reduce the possibility of POD.…”

Section: Discussionmentioning

confidence: 99%

Effect of Remimazolam on Postoperative Delirium in Older Adult Patients Undergoing Orthopedic Surgery: A Prospective Randomized Controlled Clinical Trial

Yang¹,

Lei²,

Qiu³

et al. 2023

DDDT

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Background: Postoperative delirium is common in older adult patients and associated with a poor prognosis. The use of benzodiazepine was identified as an independent risk factor for delirium, but there is no randomized controlled trial regarding the relationship between remimazolam, a new ultra-short acting benzodiazepine, and postoperative delirium. We designed a randomized controlled trial to evaluate if remimazolam increases the incidence of postoperative delirium compared with propofol in older adult patients undergoing orthopedic surgery with general anesthesia. Patients and Methods: We enrolled 320 patients aged more than 60 with American Society of Anesthesiologists physical status I-III who underwent orthopedic surgery. Patients were randomized to two groups to receive intraoperative remimazolam or propofol, respectively. Our primary outcome was the incidence of delirium within 3 days after surgery. Secondary outcome was emergence quality including the incidence of emergence agitation, extubation time, and length of post-anesthesia care unit (PACU) stay. Adverse events were also recorded. Results:The incidence of postoperative delirium was 15.6% in the remimazolam group and 12.4% in the propofol group (Risk ratio, 1.26; 95% CI, 0.72 to 2.21; Risk difference, 3.2%; 95% CI, −4.7% to 11.2%; P = 0.42). No significant differences were observed for time of delirium onset, duration of delirium, and delirium subtype between the two groups. Patients in remimazolam group had a lower incidence of hypotension after induction and consumed less vasoactive drugs intraoperatively, but had a longer postoperative extubation time and PACU stay. Conclusion: General anesthesia with remimazolam was not associated with an increased incidence of postoperative delirium compared with propofol in older adult patients undergoing orthopedic surgery.

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“…Following the successful use of remimazolam as the primary agent for procedural sedation, there has also been preliminary experience with its use as a supplement to general anesthesia during intraoperative care [11][12][13][14][15]. In a prospective, double-blinded, randomized controlled trial, sufentanil and remifentanil were paired with either remimazolam or propofol for the induction and maintenance of general anesthesia during adult urologic surgery [11]. In the remimazolam group, anesthesia was induced with remimazolam (0.2 -0.3 mg/kg) and sufentanil (0.3 -0.5 µg/kg) and then maintained with remimazolam (1 -2 mg/kg/h) and remifentanil (0.2 -0.3 µg/kg/min).…”

Section: Discussionmentioning

confidence: 99%

Remimazolam in a Pediatric Patient With a Suspected Family History of Malignant Hyperthermia

2022

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Malignant hyperthermia (MH) is an acute hypermetabolic crisis, triggered in susceptible patients by the administration of succinylcholine or a volatile anesthetic agent. When providing anesthetic care for MH-susceptible patients, a total intravenous anesthetic technique with propofol or other sedative hypnotic is frequently chosen. Remimazolam is a novel benzodiazepine which, like midazolam, has sedative, anxiolytic, and amnestic properties. Ester metabolism results in a half-life of 5-10 min and a limited context sensitive half-life. We present anecdotal experience with its use as an adjunct to propofol anesthesia in a patient with a suspected family history of MH. Previous reports of the use of remimazolam in MH-susceptible patients are reviewed and its potential role in such patients discussed.

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Quality of Recovery After General Anesthesia with Remimazolam in Patients’ Undergoing Urologic Surgery: A Randomized Controlled Trial Comparing Remimazolam with Propofol

Cited by 45 publications

References 41 publications

Sedative effect of remimazolam combined with alfentanil in colonoscopic polypectomy: a prospective, randomized, controlled clinical trial

Sedative effect of remimazolam combined with alfentanil in colonoscopic polypectomy: a prospective, randomized, controlled clinical trial

Effect of Remimazolam on Postoperative Delirium in Older Adult Patients Undergoing Orthopedic Surgery: A Prospective Randomized Controlled Clinical Trial

Remimazolam in a Pediatric Patient With a Suspected Family History of Malignant Hyperthermia

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