瑞马唑仑用于病态肥胖患者全身麻醉的有效性和安全性

Efficacy and safety of remimazolam tosylate for general anesthesia in morbidly obese patients

目的评估瑞马唑仑在病态肥胖患者全身麻醉应用中的有效性和安全性。方法选取在本中心接受腹腔镜下袖状胃切除的病态肥胖患者(BMI≥40)108例,男46例,女62例。年龄18~51岁,ASA I~III级。随机分为瑞马唑仑组(R组)和丙泊酚组(P组),分别接受瑞马唑仑或丙泊酚作为全身麻醉的诱导和维持,对比两组不良事件的发生率及术后恢复情况。结果在全身麻醉诱导期间,P组不良事件的发生率更高,包括低血压(P<0.01)、低氧血症(P<0.05)、心动过缓(P<0.01)及对血管活性药物的需求增加(P<0.05)。P组意识消失和BIS下降到60的时间短于R组(P<0.01)。两组在术后恢复质量(QoR-40评分)、术后24 h疼痛视觉模拟(VAS)评分及吗啡消耗量方面差异无统计学意义。结论瑞马唑仑可有效降低病态肥胖患者全身麻醉诱导期低血压和低氧血症的发生率,且在术后恢复质量方面与丙泊酚相当。

Aim To evaluate the effectiveness and safety of remimazolam tosylate for administering general anesthesia in morbidly obese patients.Methods This clinical trial was conducted at a single center from December 2021 to October 2023.It assessed 108 morbidly obese patients(body mass index,BMI≥40)who underwent laparoscopic sleeve gastrectomy.Patients were randomly assigned to either the remimazaolam group(Group R)or the propofol group(Group P)for general anesthesia induction and maintenance.The primary outcome was to compare the incidence of adverse events and postoperative recovery characteristics between the two groups.Results During induction period,the incidence of adverse events was higher in group P,including hypotension(P<0.01),hypoxemia(P<0.05),bradycardia(P<0.01),and increased vasopressor requirement(P<0.05).The time to loss of consciousness and BIS falling to 60 was shorter in group P than in group R(P<0.01).There were no statistically significant differences between the two groups in terms of postoperative quality of recovery(QoR-40 score),24-hour postoperative pain visual analogue scale(VAS)scores and morphine consumption.In conclusion,remimazolam tosylate,utilized for anesthesia induction in morbidly obese patients,significantly reduced hypotension and hypoxemia compared to propofol,while it could also maintain similar postoperative recovery quality.Conclusions Remimazolam is effective in reducing the incidence of hypotension and hypoxaemia during the induction period of general anaesthesia in morbidly obese patients and it is comparable to propofol in terms of quality of postoperative recovery.