瑞马唑仑在衰弱老年患者麻醉诱导致意识消失的半数有效量

Median effective dose of remimazolam for loss of consciousness during anesthesia induction in frail elderly patients

目的测定衰弱老年患者行择期非心脏手术时使用瑞马唑仑进行全身麻醉诱导致意识消失的半数有效量(ED_(50))。方法纳入2023年4月至8月于中国人民解放军联勤保障部队第九六〇医院行择期全身麻醉非心脏手术的衰弱老年患者23例。采用序贯法测定瑞马唑仑半数有效剂量,瑞马唑仑首次静脉注射剂量为0.2 mg/kg,记录患者用药后2 min内患者意识消失情况,患者意识消失后予以舒芬太尼、罗库溴铵后置入喉罩。通过Probit回归法建立回归方程,测定其应用于组内患者的ED_(50)、95%有效剂量(ED 95)及对应的95%CI并绘制量效关系图;同时观察瑞马唑仑注射后1 min(T2)、3 min(T3)、喉罩置入时(T4)患者血流动力学指标较麻醉诱导前(T1)测量值是否发生变化,并记录不良反应发生情况。采用SPSS 26.0软件进行数据分析。组内比较采用重复测量方差分析。结果瑞马唑仑在衰弱老年患者致意识消失的ED_(50)为0.091 mg/kg(95%CI 0.057~0.118 mg/kg),ED 95为0.142 mg/kg(95%CI 0.116~0.352 mg/kg);入组患者的T2、T3、T4测得的平均动脉压较T1测量值显著降低(P<0.05),但其下降幅度低于基线值20%;各时间点心率,脉搏血氧饱和度差异无统计学意义;2例患者在瑞马唑仑注射后2 min内观察到呃逆,均为一过性。结论瑞马唑仑在衰弱老年患者全身麻醉诱导时致意识消失的ED_(50)为0.091 mg/kg,诱导过程血流动力学稳定,不良反应发生率低。

Objective To determine the median effective dose(ED_(50))of remidazolam for inducing loss of consciousness during general anesthesia induction in frail elderly patients undergoing elective non-cardiac surgery.Methods A total of 23 frail elderly patients who underwent elective non-cardiac surgery with general anesthesia in our hospital from April 2023 to August 2023 were enrolled in this study.Sequential method was used to determine the median effective dose of remimazolam.After a first intravenous injection dose of 0.2 mg/kg was given,their consciousness status within two minutes after medication was recorded.After the disappearance of consciousness,sulfentanil and rocuronium were administered before placement of a laryngeal mask.Regression equations were established with Probit regression.The 50%effective dose(ED_(50)),95%effective dose(ED_(95)),and corresponding 95%CI were measured for the patients,and a dose-effect relationship diagram was plotted.The hemodynamic indicators at one(T2)and three minutes after anesthesia(T3),as well as the time of laryngeal mask placement(T4)were noted and compared with these indicators before anesthesia induction(T1).The occurrence of adverse reactions were recorded as well.SPSS statistics 26.0 was used for statistical analysis.Repeated measures ANOVA was performed to compare the data within the group.Results Remimazolam′s ED_(50)of causing loss of consciousness in frail elderly patients was 0.091 mg/kg(95%CI 0.057-0.118 mg/kg),and its ED 95 was 0.142 mg/kg(95%CI 0.116-0.352 mg/kg).The mean arterial pressure at T2,T3 and T4 was significantly lower than that at T1(P<0.05),but the decline was 20%lower than the baseline.There were no statistical differences in heart rates and pulse oxygen saturation at all above points.Hiccup was observed in two patients within two minutes after remimazolam injection,and both of them were transient.Conclusion For frail elderly patients,the ED_(50)of remimazolam is 0.091 mg/kg in inducing loss of consciousness during general anesthesia induction,with stable hemodynamic parameters and low incidence of adverse reactions.