Effect of remimazolam vs propofol on emergence from general anesthesia in patients undergoing cerebral endovascular procedures: A randomized controlled, non-inferiority trial

医学 麻醉 异丙酚 随机对照试验 改良兰金量表 发作性谵妄 谵妄 地氟醚 入射(几何) 外科 七氟醚 内科学 缺血 重症监护医学 缺血性中风 物理 光学
作者
Junbao Zhang,Jiuxiang Zhang,Yunying Wang,Xiaoguang Bai,Qingdong Guo,Wei Liu,Hui Li,Fei Zhu,Xiaohui Wang,Xiaofan Jiang,Hailong Dong,Hao-Peng Zhang,Zhihong Lu
出处
期刊:Journal of Clinical Anesthesia [Elsevier BV]
卷期号:93: 111356-111356 被引量:16
标识
DOI:10.1016/j.jclinane.2023.111356
摘要

This study aimed to compare the time to emergence from general anesthesia with remimazolam versus propofol in patients undergoing cerebral endovascular procedures. A prospective, double-blind, randomized controlled, non-inferiority trial. An academic hospital. Adult patients scheduled for cerebral endovascular procedures. Patients were randomized at a 1:1 ratio to undergo surgery under general anesthesia with remimazolam (0.1 mg kg−1 for induction and 0.3–0.7 mg kg−1 h−1 for maintenance) or propofol (1–1.5 mg kg−1 for induction and 4–10 mg kg−1 h−1 for maintenance). The primary outcome was the time to emergence from anesthesia. The non-inferiority margin was −2.55 min in group difference. Major secondary outcomes included hypotension during induction, incidence of postoperative delirium and Modified Rankin Scale (mRs) at 30 days and 90 days after surgery. Of the 142 randomized patients, 129 completed the trial. In the modified intention-to-treat analysis, the mean time to emergence from anesthesia was 16.1 [10.4] min in the remimazolam group vs. 19.0 [11.2] min in the propofol group. The group difference was −2.9 min [95% CI -6.5, 0.7] (P = 0.003 for non-inferiority). The remimazolam group had lower rate of hypotension during induction (11.3% vs 25.4%, P = 0.03) and use of vasopressors during surgery (29.6% vs 62.0%, P < 0.001). The two groups did not differ in postoperative delirium and mRs at 30 and 90 days after surgery. In patients undergoing cerebral endovascular procedures, remimazolam did not increase the time from anesthesia vs propofol.
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