Abstract：
OBJECTIVE: There is scarce evidence on the hemodynamic stability of remimazolam during anesthetic induction in patients with significant coronary artery disease. This study aims to compare the effects of remimazolam and propofol on post-induction hypotension in patients undergoing coronary artery bypass grafting (CABG).
METHODS: Randomized controlled trial.
METHODS: Tertiary teaching hospital.
METHODS: Adult patients undergoing isolated CABG.
METHODS: Patients were randomly allocated to received either remimazolam (n = 50) or propofol (n = 50) for anesthetic induction. The remimazolam group received an initial infusion at 6 mg/kg/h, which was later adjusted to 1-2 mg/kg/h to maintain a bispectral index of 40-60 after loss of consciousness. In the propofol group, a 1.5 mg/kg bolus of propofol was administered, followed by 1-1.5% sevoflurane inhalation as needed to achieve the target bispectral index.
METHODS: The primary outcome was the area under the curve (AUC) below the baseline mean arterial pressure (MAP) during the first 10 min after anesthetic induction. Secondary outcomes included the AUC for MAP <65 mmHg and the requirement for vasopressors.
RESULTS: The remimazolam group demonstrated a significantly lower AUC under the baseline MAP compared to the propofol group (mean [SD], 169.8 [101.0] mmHg·min vs. 220.6 [102.4] mmHg·min; mean difference [95% confidence interval], 50.8 [10.4-91.2] mmHg·min; P = 0.014). Additionally, the remimazolam group had a reduced AUC for MAP <65 mmHg (7.3 [10.3] mmHg·min vs. 13.9 [14.9] mmHg·min; P = 0.007) and a lower frequency of vasopressor use compared to the propofol group (60% vs. 88%, P = 0.001).
CONCLUSIONS: Remimazolam may offer improved hemodynamic stability during anesthetic induction in patients undergoing CABG, suggesting its potential advantage over propofol for patients with significant coronary artery disease in terms of hemodynamic stability.
METHODS: Randomized controlled trial.
METHODS: Tertiary teaching hospital.
METHODS: Adult patients undergoing isolated CABG.
METHODS: Patients were randomly allocated to received either remimazolam (n = 50) or propofol (n = 50) for anesthetic induction. The remimazolam group received an initial infusion at 6 mg/kg/h, which was later adjusted to 1-2 mg/kg/h to maintain a bispectral index of 40-60 after loss of consciousness. In the propofol group, a 1.5 mg/kg bolus of propofol was administered, followed by 1-1.5% sevoflurane inhalation as needed to achieve the target bispectral index.
METHODS: The primary outcome was the area under the curve (AUC) below the baseline mean arterial pressure (MAP) during the first 10 min after anesthetic induction. Secondary outcomes included the AUC for MAP <65 mmHg and the requirement for vasopressors.
RESULTS: The remimazolam group demonstrated a significantly lower AUC under the baseline MAP compared to the propofol group (mean [SD], 169.8 [101.0] mmHg·min vs. 220.6 [102.4] mmHg·min; mean difference [95% confidence interval], 50.8 [10.4-91.2] mmHg·min; P = 0.014). Additionally, the remimazolam group had a reduced AUC for MAP <65 mmHg (7.3 [10.3] mmHg·min vs. 13.9 [14.9] mmHg·min; P = 0.007) and a lower frequency of vasopressor use compared to the propofol group (60% vs. 88%, P = 0.001).
CONCLUSIONS: Remimazolam may offer improved hemodynamic stability during anesthetic induction in patients undergoing CABG, suggesting its potential advantage over propofol for patients with significant coronary artery disease in terms of hemodynamic stability.
摘要：
目的：对于有显著冠状动脉疾病的患者，在麻醉诱导过程中瑞马唑仑的血流动力学稳定性缺乏证据。本研究旨在比较瑞咪唑安定和丙泊酚对冠状动脉旁路移植术（CABG）患者诱导后低血压的影响。
方法：随机对照试验。
方法：三级教学医院。
方法：接受单纯CABG的成年患者。
方法：患者被随机分配接受雷米唑仑（n=50）或丙泊酚（n=50）麻醉诱导。瑞马唑仑组接受6mg/kg/h的初始输注，后来调整为1-2mg/kg/h，以维持意识丧失后的双频指数为40-60。在异丙酚组中,给予1.5mg/kg的丙泊酚，然后根据需要进行1-1.5%七氟醚吸入以达到目标脑电双频指数。
方法：主要结果是在麻醉诱导后的前10分钟内，曲线下面积（AUC）低于基线平均动脉压（MAP）。次要结果包括MAP<65mmHg的AUC和对血管加压药的需求。
结果：与丙泊酚组相比，雷米马唑仑组在基线MAP下显着降低了AUC（平均值[SD]，169.8[101.0]mmHg·minvs.220.6[102.4]mmHg·min；平均差[95%置信区间]，50.8[10.4-91.2]mmHg·min;P=0.014)。此外,对于MAP<65mmHg，雷米咪唑坦组的AUC降低（7.3[10.3]mmHg·minvs.13.9[14.9]mmHg·min；P=0.007）和使用血管升压药的频率低于丙泊酚组（60％vs.88%,P=0.001)。
结论：雷马唑仑可改善CABG患者麻醉诱导期间的血流动力学稳定性，提示其在血流动力学稳定性方面优于丙泊酚对显著冠心病患者的潜在优势。
方法：随机对照试验。
方法：三级教学医院。
方法：接受单纯CABG的成年患者。
方法：患者被随机分配接受雷米唑仑（n=50）或丙泊酚（n=50）麻醉诱导。瑞马唑仑组接受6mg/kg/h的初始输注，后来调整为1-2mg/kg/h，以维持意识丧失后的双频指数为40-60。在异丙酚组中,给予1.5mg/kg的丙泊酚，然后根据需要进行1-1.5%七氟醚吸入以达到目标脑电双频指数。
方法：主要结果是在麻醉诱导后的前10分钟内，曲线下面积（AUC）低于基线平均动脉压（MAP）。次要结果包括MAP<65mmHg的AUC和对血管加压药的需求。
结果：与丙泊酚组相比，雷米马唑仑组在基线MAP下显着降低了AUC（平均值[SD]，169.8[101.0]mmHg·minvs.220.6[102.4]mmHg·min；平均差[95%置信区间]，50.8[10.4-91.2]mmHg·min;P=0.014)。此外,对于MAP<65mmHg，雷米咪唑坦组的AUC降低（7.3[10.3]mmHg·minvs.13.9[14.9]mmHg·min；P=0.007）和使用血管升压药的频率低于丙泊酚组（60％vs.88%,P=0.001)。
结论：雷马唑仑可改善CABG患者麻醉诱导期间的血流动力学稳定性，提示其在血流动力学稳定性方面优于丙泊酚对显著冠心病患者的潜在优势。
