Remimazolam benzenesulfonate anesthesia effectiveness in cardiac surgery patients under general anesthesia

Abstract

BACKGROUND Sedation with propofol injections is associated with a risk of addiction, but remimazolam benzenesulfonate is a comparable anesthetic with a short elimination half-life and independence from cell P450 enzyme metabolism. Compared to remimazolam, remimazolam benzenesulfonate has a faster effect, is more quickly metabolized, produces inactive metabolites and has weak drug interactions. Thus, remimazolam benzenesulfonate has good effectiveness and safety for diagnostic and operational sedation. AIM To investigate the clinical value of remimazolam benzenesulfonate in cardiac surgery patients under general anesthesia. METHODS A total of 80 patients who underwent surgery in the Department of Cardiothoracic Surgery from August 2020 to April 2021 were included in the study. Using a random number table, patients were divided into two anesthesia induction groups of 40 patients each: remimazolam (0.3 mg/kg remimazolam benzenesulfonate) and propofol (1.5 mg/kg propofol). Hemodynamic parameters, inflammatory stress response indices, respiratory function indices, perioperative indices and adverse reactions in the two groups were monitored over time for comparison. RESULTS At pre-anesthesia induction, the remimazolam and propofol groups did not differ regarding heart rate, mean arterial pressure, cardiac index or volume per wave index. After endotracheal intubation and when the sternum was cut off, mean arterial pressure and volume per wave index were significantly higher in the remimazolam group than in the propofol group ( P < 0.05). After endotracheal intubation, the oxygenation index and the respiratory index did not differ between the groups. After endotracheal intubation and when the sternum was cut off, the oxygenation index values were significantly higher in the remimazolam group than in the propofol group ( P < 0.05). Serum interleukin-6 and tumor necrosis factor-α levels 12 h after surgery were significantly higher than before surgery in both groups ( P < 0.05). The observation indices were re-examined 2 h after surgery, and the epinephrine, cortisol and blood glucose levels were significantly higher in the remimazolam group than in the propofol group ( P < 0.05). The recovery and extubation times were significantly lower in the remimazolam group than in the propofol group ( P < 0.05); there were significantly fewer adverse reactions in the remimazolam group (10.00%) than in the propofol group (30.00%; P < 0.05). CONCLUSION Compared with propofol, remimazolam benzenesulfonate benefited cardiac surgery patients under general anesthesia by reducing hemodynamic fluctuations. Remimazolam benzenesulfonate influenced the surgical stress response and respiratory function, thereby reducing anesthesia-related adverse reactions...

Remimazolam: An Updated Review of a New Sedative and Anaesthetic

“…Remimazolam decreased the incidence of hypotension and low SpO 2 . 49 , 52 The safety data of ASA class III patients were in line with the corresponding data from patients with ASA class I and II. 50 Remimazolam could reduce the incidence of postoperative nausea and vomiting in the patients after laparoscopic gynaecological surgery under general anaesthesia as compared with desflurane (27% vs 60%, P=0.02) during the early postoperative period.…”

“…51 Moreover, remimazolam was proven effective for use in general anaesthesia among patients undergoing cardiac surgery by reducing hemodynamic fluctuations; moreover, the amount of norepinephrine was significantly lower, as compared with that in the propofol group. 52,53 It was concluded that remimazolam can safely avoid the risk of cardiac suppression when used in general anaesthesia among patients with severe aortic stenosis. 54 RT was first compared with propofol for use in general anaesthesia among patients with liver cirrhosis (ASA class II or III) undergoing endoscopic variceal ligation (EVL) (ChiCTR2100045710).…”

Application effects of remimazolam and propofol on elderly patients undergoing hip replacement

“…Although Tang’s study is different from the operation type, inflammatory index and time point of this study, it still deserves good reference. Their study also claimed that compared with propofol, remimazolam benefited cardiac surgery patients under general anesthesia by reducing hemodynamic fluctuations [ 19 ]. Our study showed that there were statistical differences in the heart rate, MAP, plasma epinephrine, norepinephrine and cortisol in the two groups from the aspect of interaction effect, and the heart rate and MAP at T 1 , T 2 and T 3 in the two groups were significantly decreased compared with those at T 0 , and the levels of plasma epinephrine, norepinephrine and cortisol in the two groups were significantly increased at 24 h and 72 h after surgery compared with those before anesthesia induction but the levels were significantly lower in the remimazolam group than those in the propofol group, and the heart rate and MAP at T 1 , T 2 and T 3 in the remimazolam group were significantly higher than those in the propofol group, indicating that the influence of remimazolam on circulation is smaller than that of propofol during induction and remimazolam can maintain a more stable heart rate and MAP after induction and is more conducive to relieving the stress response of elderly patients during anesthesia.…”

Remimazolam for Sedation During Upper Gastrointestinal Endoscopy in an Adolescent

“…As an esterbased medication, it is hydrolyzed quickly with a more rapid offset than midazolam and a limited context-sensitive half-life. Initial clinical experience in adults has demonstrated its efficacy for procedural sedation as well as an acceptable safety profile that includes limited effects on hemodynamic function, lack of pain with intravenous administration, organ-independent metabolic clearance, a reduced incidence of PONV, and a rapid return to baseline neurologic function [10][11][12][13][14].…”