背景:雷马唑仑不仅比丙泊酚具有较低的呼吸抑制发生率,而且其本身也具有呼吸抑制的风险。
目的:我们研究了雷米马唑仑输注后的呼吸抑制,使用靶控输注靶向不同的效应部位浓度。
方法:前瞻性,双盲,随机对照研究。
方法:三级医院,水原,韩国,从2022年4月到2022年11月。
方法:计划进行全身麻醉的一百零七名患者被随机分为三组,目标是瑞咪唑安定效应点浓度为500(RMZ-500)(n=36),1000(RMZ-1000)(n=35)和1500ngml-1(RMZ-1500)(n=36)。
方法:根据目标效应点浓度,仅输注雷马唑仑10分钟。根据SpO2下降的程度,使用以下呼吸支持来管理氧气去饱和:SpO2小于97%的颌骨推力,对于低于93%的SpO2的100%氧气输送和对于低于90%的SpO2的辅助通气。
方法:每种呼吸支持的发生率,以及呼吸变量(在基线,瑞马唑仑输注后5分钟和10分钟),并在瑞马唑仑靶控输注后10分钟观察到意识丧失。
结果:RMZ-1000和RMZ-1500均需要比RMZ-500更频繁的呼吸支持(均P<0.001),在RMZ-1000和RMZ-1500之间具有几乎相同的频率。在呼吸支持方面,RMZ-500辅助通气的发生率(2.8%)显著低于RMZ-1000(48.6%)和RMZ-1500(50%)(P<0.001).RMZ-1000和RMZ-1500在所有患者中实现了意识丧失;RMZ-500仅在86.1%的患者中实现了意识丧失(P=0.010)。在保持自主呼吸的患者中,在5和10分钟时,潮气量减少了41%至48%,呼吸频率增加了118%至158%,与基线相比,所有组均具有显着意义(P<0.001)。
结论:雷马唑仑输注,像其他苯二氮卓类药物一样,导致呼吸抑制,在较高的靶效应位点浓度下更为突出。因此,应制定相应的对策来防止氧饱和。
背景:CRIS(https://cris.nih.走吧。kr),标识符:KCT0006952。
BACKGROUND: Remimazolam is not only associated with a lower incidence of respiratory depression than propofol but also in itself has the risk of respiratory depression.
OBJECTIVE: We investigated respiratory depression following remimazolam infusion, targeting different effect-site concentrations using target-controlled infusion.
METHODS: A prospective, double-blind, randomised controlled
study.
METHODS: Tertiary hospital, Suwon, South Korea, from April 2022 to November 2022.
METHODS: One hundred and seven patients scheduled for general anaesthesia were randomised into three groups targeting remimazolam effect-site concentrations of 500 (RMZ-500) ( n = 36), 1000 (RMZ-1000) ( n = 35) and 1500 ng ml -1 (RMZ-1500) ( n = 36).
METHODS: Remimazolam was solely infused for 10 min according to target effect-site concentrations. According to the degree of SpO 2 decrease, oxygen desaturations were managed with the following respiratory supports: jaw-thrust for SpO 2 less than 97%, 100% oxygen delivery for SpO 2 less than 93% and assisted ventilation for SpO 2 less than 90%.
METHODS: The incidence of each respiratory support, along with respiratory variables (at baseline, 5 min and 10 min after remimazolam infusion) and loss of consciousness were observed for 10 min after remimazolam target-controlled infusion.
RESULTS: Both RMZ-1000 and RMZ-1500 required more frequent respiratory support than RMZ-500 (both P < 0.001), with nearly identical frequencies between RMZ-1000 and RMZ-1500. In terms of respiratory support, the incidence of assisted ventilation was significantly lower in RMZ-500 (2.8%) than RMZ-1000 (48.6%) and RMZ-1500 (50%) ( P < 0.001). RMZ-1000 and RMZ-1500 achieved loss of consciousness in all patients; RMZ-500 only achieved loss of consciousness in 86.1% of patients ( P = 0.010). In patients who maintained spontaneous respiration, tidal volume decreased by 41 to 48% and respiratory rate increased by 118 to 158% at 5 and 10 min, significantly compared to baseline in all groups ( P < 0.001).
CONCLUSIONS: Remimazolam infusion, like that of other benzodiazepines, led to respiratory depression, which was more prominent at higher target effect-site concentrations. Therefore, appropriate countermeasures should be developed to prevent oxygen desaturation.
BACKGROUND: CRIS ( https://cris.nih.go.kr ), identifier: KCT0006952.