Effect of Remimazolam on Transcranial Electrical Motor-evoked Potential in Spine Surgery: A Prospective, Preliminary, Dose-escalation Study

医学 麻醉 氟马西尼 瑞芬太尼 四分位间距 丸(消化) 肌肉松弛剂 异丙酚 苯二氮卓 外科 内科学 受体
作者
Shuichiro Kurita,Kenta Furutani,Yusuke Mitsuma,Hiroyuki Deguchi,Tomoaki Kamoda,Yoshinori Kamiya,Hiroshi Baba
出处
期刊:Journal of Neurosurgical Anesthesiology [Lippincott Williams & Wilkins]
标识
DOI:10.1097/ana.0000000000000983
摘要

Background: Some anesthetic drugs reduce the amplitude of transcranial electrical motor-evoked potentials (MEPs). Remimazolam, a new benzodiazepine, has been suggested to have little effect on MEP amplitude. This prospective, preliminary, dose-escalation study aimed to assess whether remimazolam is associated with lower MEP amplitude in a dose-dependent manner. Methods: Ten adult patients scheduled for posterior spinal fusion were included in this study. General anesthesia was induced with a continuous infusion of remifentanil and remimazolam. After the patient lost consciousness, the infusion rate of remimazolam was set to 1 mg/kg/h, and the patient underwent tracheal intubation. Baseline MEPs were recorded under 1 mg/kg/h of remimazolam in a prone position. Thereafter, the infusion rate of remimazolam was increased to 2 mg/kg/h, with a bolus of 0.1 mg/kg. Ten minutes after the increment, the evoked potentials were then recorded again. The primary endpoint was the MEP amplitude recorded in the left gastrocnemius muscle at 2 time points. Results: There was no difference in MEP amplitude recorded from the left gastrocnemius muscle before and after increasing remimazolam (median [interquartile range]: 0.93 [0.65 to 1.25] mV and 0.70 [0.43 to 1.26] mV, respectively; P =0.08). The average time from the cessation of remimazolam administration to neurological examination after surgery was 4 minutes using flumazenil. Conclusions: This preliminary study suggests that increasing remimazolam from 1 to 2 mg/kg/h might have an insignificant effect on transcranial electric MEPs.
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