瑞马唑仑用于严重主动脉瓣狭窄老年患者的麻醉诱导:一项前瞻性、观察性初步研究

瑞马唑仑用于严重主动脉瓣狭窄老年患者的麻醉诱导:一项前瞻性、观察性初步研究

贵州医科大学      麻醉与心脏电生理课题组

翻译：吴学艳   编辑：马艳燕   审校：曹莹

背景：瑞马唑仑是一种新的苯二氮卓类药物，据报道称其在麻醉诱导期间引起低血压发生率低于丙泊酚；因此，对于最易发生血流动力学不稳定的高龄主动脉瓣狭窄患者，瑞马唑仑可能是一种有价值的选择。我们目的是评估瑞马唑仑用于老年重度主动脉狭窄患者诱导时的可行性和血流动力学效应。

方法

该项前瞻性、开放性、无对照观察性试点研究于2020年11月至2021年4月在一所大学附属医院进行。研究共纳入20例65岁及以上拟在全身麻醉下行经导管或外科主动脉瓣置换术治疗的严重主动脉瓣狭窄患者;给予静脉泵注瑞马唑仑6mg/kg/h，联合瑞芬太尼0.25ug/kg/min。主要观察指标为麻醉诱导至气管插管完成之间的升压药使用剂量;次要观察指标为血流动力学变化、脑电双频指数变化以及从开始输注瑞马唑仑到意识消失时间。我们还记录了麻醉诱导期间的意识以及与死亡、危及生命的事件、延长住院时间和因永久性损伤导致的残疾相关的严重不良事件。

对20例年龄84岁[79-86岁](中位数[四分位数范围])、ASA分级为4级的患者进行分析。14/20例患者给予麻黄碱0[0-4]mg和苯肾上腺素0.1[0-0.1]mg(1例3剂，4例2剂，9例1剂)。开始输注瑞马唑仑后80秒[69-86秒]意识消失。平均动脉压在意识消失后逐渐下降，但气管插管后立即恢复。脑电双频指数值逐渐降低，在意识消失后120s达到< 60。未观察到麻醉诱导期间的意识和严重不良事件，如严重心动过缓(<40次/分)、危及生命的心律失常、心肌缺血或过敏反应。

  结果 

结论    

瑞马唑仑可作为老年严重主动脉瓣狭窄患者的麻醉诱导药物，并及时给予升压药。

原始文献来源: Nakanishi T, Sento Y, Kamimura Y, et al. Remimazolam for induction of anesthesia in elderly patients with severe aortic stenosis: a prospective, observational pilot study.[J]. BMC Anesthesiol. 2021 Dec 6;21(1):306.DOI: 10.1186/s12871-021-01530-3.

英文原文     

Remimazolam for induction of anesthesia in elderly patients with severe aortic stenosis: a prospective, observational pilot study

Abstract

Background: Remimazolam, a novel benzodiazepine, has been reported to cause less hypotension than propofol during induction of anesthesia. Therefore, remimazolam might be a valuable option in elderly patients with severe aortic stenosis who are considered to be the most vulnerable to hemodynamic instability. We aimed to evaluate the feasibility and hemodynamic efects of remimazolam as an induction agent in elderly patients with severe aortic stenosis.

Methods:This prospective, open-label, single-arm, observational pilot study was conducted in a university hospital between November 2020 and April 2021. We included 20 patients aged 65 years or older scheduled for transcatheter or surgical aortic valve replacement for severe aortic stenosis under general anesthesia. Patients were administered intravenous remimazolam infusion at 6mg/kg/h combined with 0.25μg/kg/min of remifentanil infusion. The primary outcome was the vasopressor dosage between the induction of anesthesia and the completion of tracheal intubation. The secondary outcomes included hemodynamic changes, bispectral index changes, and the time from the start of remimazolam infusion to loss of consciousness. We also recorded awareness during anesthesia induction and serious adverse events related to death, life-threatening events, prolonged hospitalizations, and disability due to permanent damage.

Results:Twenty patients aged 84 [79–86] (median [interquartile range]) with American Society of Anesthesiologists physical status 4 were analyzed. Ephedrine 0 [0–4] mg and phenylephrine 0.1 [0–0.1] mg were administered to 14/20 patients (3 doses in 1 patient, 2 doses in 4 patients, and one dose in 9 patients). Loss of consciousness was achieved at 80 [69–86] s after the remimazolam infusion was started. The mean arterial pressure decreased gradually after loss of consciousness but recovered immediately after tracheal intubation. The bispectral index values gradually decreased and reached <60 at 120 s after loss of consciousness. Neither awareness during induction of anesthesia nor serious adverse events, such as severe bradycardia (<40bpm), life-threatening arrhythmia, myocardial ischemia, or anaphylactic reactions were observed.

Conclusions: Remimazolam could be used as an induction agent with timely bolus vasopressors in elderly patients with severe aortic stenosis.

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