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Safety and Efficacy of Remimazolam for General Anesthesia in Elderly Patients Undergoing Transurethral Surgery
Zhi Cheng1, Jiachi Li1, Ying Zhang1
1Department of Anesthesiology The Affiliated Lianyungang Hospital of Xuzhou Medical University Lianyungang Lianyungang China.
Background And Aims:
Remimazolam, a novel benzodiazepine, acts on the GABA receptor and is widely used for procedural sedation. To date, there are relatively few articles comparing remimazolam to propofol for general anesthesia in elderly urology patients. We compared the effectiveness and safety of remimazolam with flumazenil compared to propofol for general anesthesia in patients undergoing geriatric transurethral surgery.
Methods:
Ninety-six patients were randomly assigned to the propofol group (Group P) and the remimazolam group (Group R) from November 2021 to May 2022. The primary endpoints were the occurrence of hypotension during general anesthesia. The secondary outcomes included the success rate of sedation, intraoperative haemodynamic indices, perioperative inflammatory factor levels, quality of postoperative recovery, duration of extubation and PACU stay, and the incidence of adverse reactions in both groups.
Results:
Occurrence rate and duration of hypotension were lower in the remimazolam group (50% vs. 69.2%, p = 0.096; 0 [0,10] vs. 7.5 [1.24, 25]min, p = 0.008). Both groups could provide satisfactory sedation.Remimazolam had less impact on hemodynamics during induction and intraoperative process. The remimazolam group had lower QoR-15 scores on the first postoperative day, reflected in physical comfort and emotional state. The levels of IL-6 and TNF-α increased after surgery. In terms of adverse reactions, the incidence of nausea, vomiting, and hiccups in the remimazolam group was higher. Although the extubation time after antagonism in the remimazolam group was shorter, the time to reach the standard of leaving the post-anesthesia care unit in the remimazolam group was longer than in the propofol group.
Conclusion:
Remimazolam is both safe and effective for transurethral surgery in elderly patients. However, we need to be mindful of the need for monitoring after extubation and the possibility of a temporary reduction in the quality of recovery.
Insights
Remimazolam offers a safe and effective alternative to propofol for general anesthesia in elderly urology patients, showing fewer hypotensive events. However, careful postoperative monitoring is advised due to potential impacts on recovery quality.
Area of Science:
- Anesthesiology
- Pharmacology
- Geriatric Medicine
Background:
- Remimazolam, a novel benzodiazepine, targets the GABA receptor and is used for procedural sedation.
- Limited comparative studies exist on remimazolam versus propofol for general anesthesia in elderly urology patients.
- This study addresses the gap by comparing remimazolam and propofol in geriatric transurethral surgery.
Purpose of the Study:
- To compare the effectiveness and safety of remimazolam with flumazenil versus propofol for general anesthesia.
- To evaluate remimazolam's suitability for elderly patients undergoing transurethral surgery.
- To analyze hemodynamic stability, recovery quality, and adverse events.
Main Methods:
- Ninety-six elderly patients undergoing transurethral surgery were randomized into propofol (Group P) and remimazolam (Group R) groups.
- Primary endpoint: occurrence of hypotension during general anesthesia.
- Secondary outcomes: sedation success, hemodynamic indices, inflammatory markers, recovery quality, extubation time, PACU stay, and adverse reactions.
Main Results:
- Remimazolam group showed lower incidence and duration of hypotension (50% vs. 69.2%; 0 vs. 7.5 min).
- Both agents provided satisfactory sedation with less hemodynamic impact from remimazolam during induction and intraoperatively.
- The remimazolam group experienced higher rates of nausea, vomiting, and hiccups, and a longer time to PACU discharge despite shorter extubation times.
Conclusions:
- Remimazolam is safe and effective for transurethral surgery in elderly patients.
- Consideration should be given to post-extubation monitoring and potential temporary decreases in recovery quality.
- Remimazolam presents a viable anesthetic option, though specific adverse events and recovery metrics warrant attention.
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