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Comparison between remimazolam and propofol anaesthesia for interventional neuroradiology: a randomised controlled

Ji Hyeon Lee1, Jiyoun Lee1, Sang Heon Park1

  • 1Department of Anaesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.

Anaesthesia, Critical Care & Pain Medicine
|December 7, 2023
PubMed
Abstract

Insights

Remimazolam offers superior hemodynamic stability during neuroradiology procedures compared to propofol. This ultrashort-acting benzodiazepine also facilitates faster patient recovery, making it a promising anesthetic agent.

Area of Science:

  • Anesthesiology
  • Neuroradiology
  • Pharmacology

Background:

  • General anesthesia is crucial for immobilizing patients during interventional neuroradiology to enhance image quality.
  • Remimazolam, an ultrashort-acting benzodiazepine, is recognized for its potential to maintain hemodynamic stability.
  • This study aimed to compare remimazolam with propofol for anesthesia during neuroradiology procedures, focusing on intraoperative hypotension and recovery speed.

Purpose of the Study:

  • To compare the efficacy and safety of remimazolam versus propofol for anesthesia in interventional neuroradiology.
  • To evaluate intraoperative hypotensive events and the total dose of phenylephrine required to maintain hemodynamic stability.
  • To assess the speed of patient recovery following anesthesia with remimazolam compared to propofol.

Main Methods:

  • A single-masked, randomized-controlled study involving 76 participants undergoing elective endovascular embolization.
  • Patients were randomized to receive either a continuous remimazolam infusion (n=38) or a target-controlled propofol infusion (n=38).
  • Phenylephrine was used to maintain mean arterial pressure, with the total dose serving as the primary outcome; flumazenil was administered post-procedure in the remimazolam group.

Main Results:

  • The remimazolam group required significantly less phenylephrine (0.0 μg) compared to the propofol group (30.0 μg) (p=0.001).
  • Hypotensive events occurred in 28.9% of patients in the remimazolam group versus 60.5% in the propofol group (p=0.001).
  • Recovery times, including spontaneous breathing, eye-opening, extubation, and orientation, were significantly shorter with remimazolam (all p<0.001).

Conclusions:

  • Remimazolam anesthesia demonstrated superior hemodynamic stability compared to propofol during neuroradiology procedures.
  • The systematic administration of flumazenil facilitated a rapid and effective recovery from remimazolam anesthesia.
  • Remimazolam presents a favorable alternative for anesthesia in neuroradiology, offering improved hemodynamic control and faster patient recovery.
Keywords:
FlumazenilInterventionNeuroradiologyPropofolRemimazolam

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