Effect of remimazolam tosylate on the response to endotracheal intubation under general anesthesia in patients undergoing catheter placement for peritoneal dialysis.

Abstract

Objective: This study aims to observe the effects of remimazolam tosylate on the response to endotracheal intubation under general anesthesia in patients undergoing peritoneal dialysis catheter placement. Additionally, we seek to determine the 95% effective dose (ED95) of remimazolam tosylate for inhibiting the endotracheal intubation response in this patient population.

Methods: This prospective study was registered with the China Clinical Trials Center (ChiCTR2200055709), https://www.chictr.org.cn/showproj.html?proj=149640. Patients scheduled for peritoneal dialysis catheter placement under general anesthesia at the First Affiliated Hospital of Nanchang University between January and June 2023 were selected. They were randomly assigned into the remimazolam tosylate group (R group) and the propofol group (P group), with 30 patients in each group. After anesthesia induction and subsequent endotracheal intubation, sedation efficacy and adverse reactions were recorded for both groups. Venous blood samples (1 mL) were collected from patients before anesthesia induction and after endotracheal intubation to measure levels of adrenaline and noradrenaline. The modified Dixon sequential method was used to determine the ED95 of remimazolam tosylate for inhibiting the endotracheal intubation response.

Results: Levels of adrenaline and noradrenaline decreased significantly after endotracheal intubation in both the R group and P group, with no significant difference. Vital signs were more stable in the R group compared to the P group. Injection pain during anesthesia induction was reported in 3 patients (10%) in the R group, whereas 18 cases (60%) were observed in the P group. The Dixon sequential experiment included a total of 25 patients, with 13 (52%) showing positive responses and 12 (48%) negative responses.

Conclusions: Remimazolam tosylate is effective for inhibiting the systemic response to endotracheal intubation in patients undergoing peritoneal dialysis catheter placement. Additionally, the occurrence rate of hypotension and injection pain during anesthesia induction is significantly lower compared to propofol. The ED95 of remimazolam tosylate for inhibiting the endotracheal intubation response in peritoneal dialysis catheter placement patients is 0.332 mg/kg.