用于儿科患者麻醉和镇静的雷马唑仑:范围界定综述。

IF 2.8 3区 医学 Q2 ANESTHESIOLOGY
Journal of Anesthesia Pub Date : 2024-10-01 Epub Date: 2024-06-07 DOI:10.1007/s00540-024-03358-w
Marina Pieri, Jacopo D'Andria Ursoleo, Ambra Licia Di Prima, Samuele Bugo, Gaia Barucco, Margherita Licheri, Rosario Losiggio, Giovanna Frau, Fabrizio Monaco
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引用次数: 0

摘要

儿科患者的麻醉管理面临着诸多挑战,而在这一人群中使用哪种麻醉剂最合适仍是一个争论不休的问题。我们系统地检索了 PubMed/MEDLINE 和 Google Scholar,以了解新型超短效苯二氮卓类药物雷马唑仑在儿科患者中的作用和潜在应用。此外,2024 年 3 月,对文献检索进行了更新,并在 EMBASE 数据库中进行了额外的事后检索。在 2021-2023 年期间,共有 14 项相关研究探讨了将雷马唑仑作为诱导和/或维持全身麻醉或镇静的主要或辅助催眠药。这些研究得出的初步证据强调,对于儿科患者,尤其是同时患有线粒体疾病、肌病或有恶性高热风险的患者,雷马唑仑是一种安全有效的镇静和全身麻醉选择。此外,目前的证据表明,雷马唑仑可能有助于减轻儿童的术前焦虑和术后谵妄。其良好的药效学和药代动力学特征表明,在各种儿科围手术期情况下,该药具有潜在的安全性、有效性和易用性,因此适合纳入特定的方案,如术中监测诱发电位和处理困难插管。尽管这些研究结果前景广阔,但仍有必要开展进一步研究,以确定最佳剂量、确立其优于其他苯二氮卓类药物的确凿证据,并阐明遗传因素对药物代谢的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Remimazolam for anesthesia and sedation in pediatric patients: a scoping review.

Remimazolam for anesthesia and sedation in pediatric patients: a scoping review.

Anesthetic management of pediatric patients poses several challenges and the optimal anesthetic agent for use in this population is still a matter of debate. We systematically searched PubMed/MEDLINE and Google Scholar from their inception for studies that investigated the role and potential applications of remimazolam, a novel ultra-short-acting benzodiazepine, in pediatric patients. Furthermore, in March 2024, an update of the literature search along with an additional post-hoc search on the EMBASE database were performed. A total of fourteen pertinent studies which spanned the 2021-2023 period explored remimazolam as either the primary or adjuvant hypnotic agent for inducing and/or maintaining general anesthesia or sedation. Preliminary evidence derived from these studies highlighted that remimazolam is a safe and effective option for both sedation and general anesthesia in pediatric patients, particularly those with concurrent mitochondrial disorders, myopathic diseases, or at risk for malignant hyperthermia. Moreover, the current evidence suggested that remimazolam may contribute to reducing preoperative anxiety and postoperative delirium in children. Its favorable pharmacodynamic and pharmacokinetic profile demonstrated potential safety, effectiveness, and ease-of-use in various perioperative pediatric contexts, making it suitable for integration into specific protocols, such as intraoperative monitoring of evoked potentials and management of difficult intubation. Notwithstanding these promising findings, further research is essential to determine optimal dosages, establish conclusive evidence of its superiority over other benzodiazepines, and elucidate the impact of genetic factors on drug metabolism.

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来源期刊
Journal of Anesthesia
Journal of Anesthesia 医学-麻醉学
CiteScore
5.30
自引率
7.10%
发文量
112
审稿时长
3-8 weeks
期刊介绍: The Journal of Anesthesia is the official journal of the Japanese Society of Anesthesiologists. This journal publishes original articles, review articles, special articles, clinical reports, short communications, letters to the editor, and book and multimedia reviews. The editors welcome the submission of manuscripts devoted to anesthesia and related topics from any country of the world. Membership in the Society is not a prerequisite. The Journal of Anesthesia (JA) welcomes case reports that show unique cases in perioperative medicine, intensive care, emergency medicine, and pain management.
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