Remimazolam to prevent hemodynamic instability during catheter ablation under general anesthesia: a randomized controlled trial.

IF 3.4 3区医学 Q1 ANESTHESIOLOGY

Canadian Journal of Anesthesia-Journal Canadien D Anesthesie Pub Date : 2024-08-01 Epub Date: 2024-04-12 DOI:10.1007/s12630-024-02735-z

Subin Yim, Chang Ik Choi, Insun Park, Bon Wook Koo, Ah Young Oh, In-Ae Song

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引用次数: 0

Abstract

Purpose: Maintaining hemodynamic stability during cardiac ablation under general anesthesia is challenging. Remimazolam, a novel ultrashort-acting benzodiazepine, is characterized by maintaining comparatively stable blood pressure and does not influence the cardiac conduction system, which renders it a reasonable choice for general anesthesia for cardiac ablation. We aimed to evaluate whether remimazolam is associated with a decreased incidence of intraoperative hypotension compared with desflurane.

Methods: In this single-centre, parallel-group, prospective, single-blind, randomized clinical trial, we randomized patients (1:1) into a remimazolam group (remimazolam-based total intravenous anesthesia) or desflurane group (propofol-induced and desflurane-maintained inhalational anesthesia) during cardiac ablation procedures for arrhythmia. The primary outcome was the incidence of intraoperative hypotensive events, defined as mean arterial pressure of < 60 mm Hg at any period.

Results: Overall, we enrolled 96 patients between 2 August 2022 and 19 May 2023 (47 and 49 patients in the remimazolam and desflurane groups, respectively). The remimazolam group showed a significantly lower incidence of hypotensive events (14/47, 30%) than the desflurane group (29/49, 59%; relative risk [RR], 0.5; 95% confidence interval [CI], 0.31 to 0.83; P = 0.004). Remimazolam was associated with a lower requirement for bolus or continuous vasopressor infusion than desflurane was (23/47, 49% vs 43/49, 88%; RR, 0.56; 95% CI, 0.41 to 0.76; P < 0.001). No between-group differences existed in the incidence of perioperative complications such as nausea, vomiting, oxygen desaturation, delayed emergence, or pain.

Conclusions: Remimazolam was a viable option for general anesthesia for cardiac ablation. Remimazolam-based total intravenous anesthesia was associated with significantly fewer hypotensive events and vasopressor requirements than desflurane-based inhalational anesthesia was, without significantly more complications.

Study registration: ClinicalTrials.gov (NCT05486377); first submitted 1 August 2022.

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雷马唑仑预防全身麻醉下导管消融过程中的血流动力学不稳定：随机对照试验。

目的：在全身麻醉下进行心脏消融术时保持血流动力学稳定具有挑战性。雷马唑仑是一种新型超短效苯二氮卓类药物，其特点是能维持相对稳定的血压，且不影响心脏传导系统，因此是心脏消融术全身麻醉的合理选择。我们的目的是评估与地氟醚相比，雷马唑仑是否能降低术中低血压的发生率：在这项单中心、平行组、前瞻性、单盲、随机临床试验中，我们在心律失常的心脏消融术中将患者（1:1）随机分为雷马唑仑组（基于雷马唑仑的全静脉麻醉）或地氟醚组（异丙酚诱导和地氟醚维持的吸入麻醉）。主要结果是术中低血压事件的发生率，即平均动脉压结果：在 2022 年 8 月 2 日至 2023 年 5 月 19 日期间，我们共招募了 96 名患者（瑞美唑仑组和地氟醚组分别有 47 名和 49 名患者）。雷马唑仑组的低血压事件发生率（14/47，30%）明显低于地氟醚组（29/49，59%；相对风险 [RR]，0.5；95% 置信区间 [CI]，0.31 至 0.83；P = 0.004）。与地氟醚相比，雷马唑仑对栓塞或持续输注血管加压药的需求更低（23/47，49% vs 43/49，88%；RR，0.56；95% CI，0.41 to 0.76；P 结论：雷马唑仑是一种可行的治疗方法：雷马唑仑是心脏消融术全身麻醉的可行选择。与地氟醚吸入麻醉相比，基于雷马唑仑的全凭静脉麻醉的低血压事件和血管加压剂需求明显更少，但并发症明显更多：研究注册：ClinicalTrials.gov（NCT05486377）；2022年8月1日首次提交。

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来源期刊

Canadian Journal of Anesthesia-Journal Canadien D Anesthesie 医学-麻醉学

CiteScore

8.50

自引率

7.10%

发文量

161

审稿时长

6-12 weeks

期刊介绍： The Canadian Journal of Anesthesia (the Journal) is owned by the Canadian Anesthesiologists’ Society and is published by Springer Science + Business Media, LLM (New York). From the first year of publication in 1954, the international exposure of the Journal has broadened considerably, with articles now received from over 50 countries. The Journal is published monthly, and has an impact Factor (mean journal citation frequency) of 2.127 (in 2012). Article types consist of invited editorials, reports of original investigations (clinical and basic sciences articles), case reports/case series, review articles, systematic reviews, accredited continuing professional development (CPD) modules, and Letters to the Editor. The editorial content, according to the mission statement, spans the fields of anesthesia, acute and chronic pain, perioperative medicine and critical care. In addition, the Journal publishes practice guidelines and standards articles relevant to clinicians. Articles are published either in English or in French, according to the language of submission.