Effects of Remimazolam Anesthesia in Patients Undergoing Deep Inferior Epigastric Perforator Flap Reconstruction for...

Area of Science:

• Anesthesiology
• Plastic Surgery
• Surgical Oncology

Background:

• Vasopressors used in deep inferior epigastric perforator (DIEP) free flap surgery can cause vasoconstriction, potentially compromising flap perfusion and increasing complication risks.
• Optimizing anesthetic techniques is crucial for maintaining hemodynamic stability and improving outcomes in complex reconstructive procedures like DIEP flaps.

Purpose of the Study:

• To evaluate the impact of remimazolam-based anesthesia on intraoperative vasopressor requirements in patients undergoing DIEP flap breast reconstruction.
• To compare postoperative outcomes between remimazolam anesthesia and conventional anesthetic regimens (sevoflurane, propofol).

Main Methods:

• A retrospective cohort study involving 75 patients undergoing DIEP flap procedures between March 2021 and March 2022.
• Patients were categorized based on their anesthetic regimen: sevoflurane, propofol, or remimazolam.
• The primary endpoint was the total intraoperative norepinephrine requirement.

Main Results:

• The remimazolam group demonstrated a statistically significant reduction in intraoperative norepinephrine use compared to both sevoflurane (1558.6 µg) and propofol (926.6 µg) groups, with the remimazolam group requiring only 202.1 µg (P < 0.001).
• Similar reductions in ephedrine requirements were observed across the groups.
• Hemodynamic stability was potentially better maintained with remimazolam.

Conclusions:

• Remimazolam anesthesia is associated with significantly lower intraoperative vasopressor requirements in DIEP flap breast reconstruction.
• Remimazolam presents a viable alternative anesthetic agent, potentially enhancing hemodynamic stability during DIEP free flap procedures compared to sevoflurane and propofol.