Comparison of the recovery profiles of propofol, dexmedetomidine, and remimazolam for intraoperative sedation in patients undergoing upper limb surgery under brachial plexus blockade: a randomized controlled trial.

IF 3.3 3区医学 Q1 ANESTHESIOLOGY

Canadian Journal of Anesthesia-Journal Canadien D Anesthesie Pub Date : 2025-07-01 Epub Date: 2025-06-13 DOI:10.1007/s12630-025-02987-3

Ha-Jung Kim, Yeon Ju Kim, Jungmin Lee, Daun Jeong, Young Ho Shin, Young-Jin Ro, Hyungtae Kim, Won Uk Koh

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引用次数: 0

Abstract

Purpose: The ideal sedative should have a rapid onset, short duration, and quick and predictable recovery. Despite the increasing use of the recently developed sedative remimazolam for intraoperative sedation, there is a paucity of research on its comparative recovery profile. Our aim was to compare the recovery profiles of intraoperative sedation with propofol, dexmedetomidine, and remimazolam in patients undergoing surgery under regional anesthesia.

Methods: We included 119 patients scheduled to undergo upper limb surgery under brachial plexus blockade in a randomized controlled trial. We randomized patients to receiving intraoperative sedation with propofol, dexmedetomidine, or remimazolam. The primary outcome was the recovery time (from the completion of infusion to attaining a Modified Observer's Assessment of Alertness and Sedation score of 5). As secondary outcomes, we assessed other recovery profiles, including length of stay, quality of recovery, and the Aldrete score.

Results: The mean (95% confidence interval [CI]) recovery time was 19 min (95% CI, 16 to 22) for patients in the dexmedetomidine group, 17 min (95% CI, 15 to 19) for the remimazolam group, and 12 min (95% CI, 10 to 13) for the propofol group (P < 0.001). Post hoc analysis revealed that the recovery time in the remimazolam group was longer compared to that in the propofol group (mean difference, 5 min; 95% CI, 3 to 8; Bonferroni adjusted P < 0.001). We found no significant differences among the three groups in the recovery-related secondary outcomes (all P > 0.05).

Conclusions: Patients in the propofol group exhibited the most rapid recovery time from intraoperative sedation under regional anesthesia, followed by those in the remimazolam and dexmedetomidine groups. We found no differences in the recovery-related secondary outcomes.

Study registration: ClinicalTrials.gov ( NCT05688345 ); first submitted 30 December 2022.

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异丙酚、右美托咪定和雷马唑仑在臂丛阻断下上肢手术患者术中镇静恢复情况的比较：一项随机对照试验。

目的：理想的镇静剂应起效快、持续时间短、恢复快且可预测。尽管最近开发的雷马唑仑用于术中镇静的使用越来越多，但对其相对恢复情况的研究却很少。我们的目的是比较异丙酚、右美托咪定和雷马唑仑在区域麻醉下手术患者术中镇静的恢复情况。方法：在一项随机对照试验中，我们纳入了119例计划在臂丛阻滞下接受上肢手术的患者。我们将患者随机分组，接受异丙酚、右美托咪定或雷马唑仑的术中镇静。主要观察结果是恢复时间（从输注完成到达到修改的观察者警觉和镇静评估评分5分）。作为次要结果，我们评估了其他恢复概况，包括住院时间、恢复质量和Aldrete评分。结果：右美托咪定组患者平均（95%可信区间[CI]）恢复时间为19 min (95% CI, 16 ~ 22)，雷马唑仑组患者平均恢复时间为17 min (95% CI, 15 ~ 19)，异丙酚组患者平均恢复时间为12 min (95% CI, 10 ~ 13) （P < 0.05）。结论：异丙酚组患者在区域麻醉下术中镇静恢复时间最快，其次是雷马唑仑组和右美托咪定组。我们发现与恢复相关的次要结局没有差异。研究注册：ClinicalTrials.gov (NCT05688345)；首次提交于2022年12月30日。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.