上下测定苯磺酸瑞马唑仑麻醉诱导的90%有效剂量（ED90）

上下测定苯磺酸瑞马唑仑麻醉诱导的90%有效剂量（ED90）

贵州医科大学    麻醉与心脏电生理课题组

翻译：吴学艳  编辑：潘志军  审校：曹莹

                            BLUE SKY                            

背景：

注射用苯磺酸瑞马唑仑是一种新型苯二氮卓类药物；合理选择和正确应用麻醉剂对患者至关重要。本研究旨在确定苯磺酸瑞马唑仑用于患者行无痛结肠镜检查时麻醉诱导 90%有效剂量(ED90)。

方法：

在 2020年 12月至 2021年 1月期间，共纳入112名接受无痛结肠镜检查的患者进行剂量-反应研究；瑞马唑仑的初始剂量为 7.5 mg，麻醉医生采用改良警觉镇静评估量表(MOAA/S)评估镇静深度是否达到满意。如果一名患者的 MOAA/S 评分 > 1分，则下一名患者的负荷剂量增加 2.5 mg；如果 MOAA/S 评分≤1 分，则根据 9:1 偏向硬币设计法，为下一位患者维持当前剂量或减少2.5 mg；计算苯磺酸瑞马唑仑用于无痛结肠镜检查的麻醉诱导ED90剂量，并记录苯磺酸瑞马唑仑的不良事件和并发症。

结果：

当药物浓度为1 mg/ml，输注速度为1000ml/h时，苯磺酸瑞马唑仑用于无痛结肠镜检查的ED90为11.43 mg[95%（CI）：9.85-13.02 mg]。

                            BLUE SKY                            

结论：

健康成人患者接受无痛结肠镜检查时，负荷剂量为12 mg的苯磺酸瑞马唑仑可安全、有效、快速地诱导患者入睡，缩短麻醉诱导时间。

原始文献来源：

Lu Z, Zhou N, Li Y, et al. Up-down determination of the 90% effective dose (ED90) of remimazolam besylate for anesthesia induction. Ann Palliat Med[J]. 2022 Feb;11(2):568-573. DOI: 10.21037/apm-22-89.

        英文原文                        

Up-down determination of the 90% effective dose (ED90) of remimazolam besylate for anesthesia induction

Abstract

Background: Remimazolam besylate for injection is a novel benzodiazepine. Reasonable selection and proper application of anesthetics is critical for patients. This study aims to determine the 90% effective dose (ED90) of remimazolam besylate for anesthesia induction in patients undergoing painless colonoscopy.

Methods: A dose-response study was carried out in 112 patients undergoing painless colonoscopy between December 2020 and January 2021. The initial dose of remimazolam was 7.5 mg. The anesthesiologist assessed whether the depth of sedation was satisfactory according to the Modified Observer's Assessment of Alertness and Sedation (MOAA/S) scale. If the MOAA/S score of one patient was >1 point, the loading dose for the next patient was increased by 2.5 mg. If the MOAA/S score was ≤1 point, the current dose was maintained or reduced by 2.5 mg for the next patient according to a 9:1 biased coin design. The ED90 of remimazolam besylate for anesthesia induction for painless colonoscopy was calculated. The adverse events and complications of remimazolam besylate were recorded.

Results: When the drug concentration was 1 mg/mL and the infusion rate was 1,000 mL/h, the ED90 of remimazolam besylate for painless colonoscopy was 11.43 mg [95% confidence interval (CI): 9.85-13.02 mg].

Conclusions: A loading dose of 12 mg remimazolam besylate for healthy adult patients undergoing painless colonoscopy can safely, effectively, and quickly induce patients to fall asleep and shorten the anesthesia induction time.

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