背景:雷马唑仑是一种新型的超短作用的静脉注射苯二氮卓镇静催眠药。雷米唑仑和七氟烷的联合使用不会增加呼吸敏感性,产生支气管痉挛,或造成其他不利条件。我们的目的是观察不同剂量的瑞马唑仑对喉罩插入过程中呼气末七氟烷最低肺泡浓度(MAC)的影响,并评估性别对瑞马唑仑组合抑制成人患者喉罩插入效果的影响。
方法:我们纳入了240名在全身麻醉下择期放置喉罩的腹腔镜手术患者(男120例,女120例)。根据性别将患者随机分为四组:对照组(随机分为女性患者,RF0;男性患者的随机化,RM0)和三个瑞马唑仑基团(RF1,RM1/RM2,RF2/RM3,RF3),每组30名患者。通过肺活量快速吸入诱导(VCRII)建立诱导,在所有患者中使用8%七氟醚和100%氧气(6L/min)。(RF1,RM1),(RM2,RF2),和(RM3,RF3)组连续注射剂量为1、1.5和2.0mg/kg/h的瑞马唑仑,分别,而(RM0,RF0)组注射等体积的生理盐水。患者睫毛反射消失后,将七氟醚呼气末浓度调整至预设值。七氟醚呼气末浓度稳定至少15分钟后,放置喉罩,并且患者对面罩放置的身体反应在放置后30s内立即观察到。使用Dixon的上下顺序方法测量七氟醚的MAC。
结果:成年女性插入喉罩期间呼气末七氟烷的计算MAC为(2.94±0.18)%,(2.69±0.16)%,RF0,RF1,RF2和RF3组的(2.32±0.16)%和(1.83±0.15)%;(2.98±0.18)%,(2.80±0.19)%,男性组RM0,RM1,RM2和RM3分别为(2.54±0.15)%和(2.15±0.15)%。与(RF0,RM0)组相比,(RF1-RF3,RM1-RM3)组的MAC值明显较低。(RF0,RF1)和(RM0,RM1)之间无明显差异,但RF2-RF3组的MAC值显著低于RM2-RM3组。
结论:雷马唑仑可有效降低成人喉罩置入期间呼气末七氟烷MAC值。当瑞米唑仑测量高于1.5mg/kg/h时,女性患者抑制喉罩植入的效果强于男性患者。在这些患者中可以安全有效地使用1-2mg/kg/h剂量的瑞马唑仑与七氟烷诱导联合使用。
BACKGROUND: Remimazolam is a novel ultrashort-acting intravenous benzodiazepine sedative-hypnotic. The combination of remimazolam and sevoflurane does not increase respiratory sensitivity, produce bronchospasm, or cause other adverse conditions. We aimed to observe the effects of different remimazolam doses on the minimum alveolar concentration (MAC) of sevoflurane at end-expiration during laryngeal mask insertion and evaluate the effect of sex on the efficacy of the combination of remimazolam on the suppression of laryngeal mask insertion in adult patients.
METHODS: We included 240 patients undergoing laparoscopic surgery under general anesthesia with elective placement of a laryngeal mask (120 males and 120 females). The patients were randomly divided into four groups according to sex: a control group (randomization for female patients, RF0; randomization for male patients, RM0) and three remimazolam groups (RF1, RM1 / RM2, RF2 / RM3, RF3), with 30 patients in each group. Induction was established by vital capacity rapid inhalation induction (VCRII), using 8% sevoflurane and 100% oxygen (6 L/min) in all patients. The (RF1, RM1), (RM2, RF2), and (RM3, RF3) groups were continuously injected with remimazolam at doses of 1, 1.5, and 2.0 mg/kg/h, respectively, while the (RM0, RF0) group was injected with an equal volume of normal saline. The end-expiratory concentration of sevoflurane was adjusted to a preset value after the patient\'s eyelash reflex disappeared. After the end-expiratory concentration of sevoflurane was kept stable for at least 15 min, the laryngeal mask was placed, and the patient\'s physical response to the mask placement was observed immediately and within 30 s of placement. The MAC of sevoflurane was measured using the up-and-down sequential method of Dixon.
RESULTS: The calculated MAC of end-expiratory sevoflurane during laryngeal mask insertion in adult females was (2.94 ± 0.18)%, (2.69 ± 0.16)%, (2.32 ± 0.16)% and (1.83 ± 0.15)% in groups RF0, RF1, RF2 and RF3; (2.98 ± 0.18)%, (2.80 ± 0.19)%, (2.54 ± 0.15)% and (2.15 ± 0.15)% in male groups RM0, RM1, RM2 and RM3, respectively. The MAC values were significantly lower in the (RF1-RF3, RM1-RM3) group when compared to the (RF0, RM0) group. There was no significant difference between (RF0, RF1) and (RM0, RM1), but the MAC value of the RF2-RF3 group was significantly lower than that of the RM2-RM3 group.
CONCLUSIONS: Remimazolam can effectively reduce end-expiratory sevoflurane MAC values during laryngeal mask placement in adults. When remimazolam was measured above 1.5 mg/kg/h, the effect of inhibiting laryngeal mask implantation in female patients was stronger than that in male patients. Remimazolam at a dose of 1-2 mg/kg/h combined with sevoflurane induction can be safely and effectively used in these patients.