Remimazolam Compared to Propofol for Total Intravenous Anesthesia with Remifentanil on the Recovery of Psychomotor Function: A Randomized Controlled Trial.
Propofol
Psychomotor function
Remifentanil
Remimazolam
TIVA
Journal
Advances in therapy
ISSN: 1865-8652
Titre abrégé: Adv Ther
Pays: United States
ID NLM: 8611864
Informations de publication
Date de publication:
10 2023
10 2023
Historique:
received:
24
05
2023
accepted:
13
07
2023
medline:
14
9
2023
pubmed:
25
7
2023
entrez:
25
7
2023
Statut:
ppublish
Résumé
This study aimed to compare remimazolam to propofol in psychomotor recovery after total intravenous anesthesia (TIVA) using the Trieger dot test. Sixty-six patients who were scheduled to undergo endoscopic sinus surgery with American Society of Anesthesiologists (ASA) physical status I or II were randomly allocated to the remimazolam (group R) or propofol group (group P). In group R, all patients received flumazenil postoperatively. After discontinuation of anesthetic agents, the time to eye opening, response to verbal commands, extubation, and discharge from the operation room were measured. Psychomotor recovery was assessed using the Trieger dot test before induction and at 0, 30, 60, 90, 120, 150, and 180 min after anesthesia. The time to eye opening, response to verbal commands, extubation, and discharge from the operation room were significantly longer in group P compared to group R (group P: 9.8 ± 3.2 min, 11.5 ± 3.4 min, 12.7 ± 3.4 min, 18.1 ± 4.2 min; group R: 6.5 ± 2 min, 7.3 ± 2.6 min, 8.4 ± 2.9 min, 13.2 ± 3.2 min; respectively, p < 0.05). In the Trieger dot test, the number of dots missed was significantly increased in group R compared to group P at 30, 60, 90, and 120 min after discharge from the operation room (group R: 20.5 ± 9.3, 16 ± 8.8, 14.9 ± 11.1, 14.3 ± 10.8; group P: 14.6 ± 7.8, 10 ± 7.1, 8.7 ± 7.3, 7.3 ± 5.7; respectively, p < 0.05). The maximum distance of dots missed was significantly increased in group R compared to group P at 30 min after discharge from the operation room (group R: 3.9 ± 2.8; group P: 2.7 ± 1.6; p < 0.05). Our results suggest that remimazolam with flumazenil leads to rapid recovery following anesthesia; however, it may cause delayed psychomotor decline. This trial is registered with the University Hospital Medical Information Network (registration number UMIN000044900).
Identifiants
pubmed: 37490257
doi: 10.1007/s12325-023-02615-w
pii: 10.1007/s12325-023-02615-w
pmc: PMC10499674
doi:
Substances chimiques
Propofol
YI7VU623SF
Remifentanil
P10582JYYK
Anesthetics, Intravenous
0
remimazolam
7V4A8U16MB
Flumazenil
40P7XK9392
Piperidines
0
Types de publication
Randomized Controlled Trial
Journal Article
Langues
eng
Pagination
4395-4404Informations de copyright
© 2023. The Author(s).
Références
Schüttler J, Eisenried A, Lerch M, Fechner J, Jeleazcov C, Ihmsen H. Pharmacokinetics and pharmacodynamics of remimazolam (CNS 7056) after continuous infusion in healthy male volunteers: part I. Pharmacokinetics and clinical pharmacodynamics. Anesthesiology. 2020;132:636–51.
doi: 10.1097/ALN.0000000000003103
pubmed: 31972655
Kilpatrick GJ, McIntyre MS, Cox RF, et al. CNS 7056: a novel ultra-short-acting benzodiazepine. Anesthesiology. 2007;107:60–6.
doi: 10.1097/01.anes.0000267503.85085.c0
pubmed: 17585216
Rogers WK, McDowell TS. Remimazolam, a short-acting GABA(A) receptor agonist for intravenous sedation and/or anesthesia in day-case surgical and non-surgical procedures. IDrugs. 2010;13:929–37.
pubmed: 21154153
Doi M, Hirata N, Suzuki T, Morisaki H, Morimatsu H, Sakamoto A. Safety and efficacy of remimazolam in induction and maintenance of general anesthesia in high-risk surgical patients (ASA class III): results of a multicenter, randomized, double-blind, parallel-group comparative trial. J Anesth. 2020;34:491–501.
doi: 10.1007/s00540-020-02776-w
pubmed: 32303884
Sneyd JR, Gambus PL, Rigby-Jones AE. Current status of perioperative hypnotics, role of benzodiazepines, and the case for remimazolam: a narrative review. Br J Anaesth. 2021;127:41–55.
doi: 10.1016/j.bja.2021.03.028
pubmed: 33965206
Doi M, Morita K, Takeda J, Sakamoto A, Yamakage M, Suzuki T. Efficacy and safety of remimazolam versus propofol for general anesthesia: a multicenter, single-blind, randomized, parallel-group, phase IIb/III trial. J Anesth. 2020;34:543–53.
doi: 10.1007/s00540-020-02788-6
pubmed: 32417976
Yao Y, Guan J, Liu L, Fu B, Chen L, Zheng X. Discharge readiness after remimazolam versus propofol for colonoscopy: a randomised, double-blind trial. Eur J Anaesthesiol. 2022;39:911–7.
doi: 10.1097/EJA.0000000000001715
pubmed: 35796575
Lee HJ, Lee HB, Kim YJ, Cho HY, Kim WH, Seo JH. Comparison of the recovery profile of remimazolam with flumazenil and propofol anesthesia for open thyroidectomy. BMC Anesthesiol. 2023;23:147.
doi: 10.1186/s12871-023-02104-1
pubmed: 37131126
pmcid: 10152604
Masui K. Remimazolam besilate, a benzodiazepine, has been approved for general anesthesia!! J Anesth. 2020;34:479–82.
doi: 10.1007/s00540-020-02755-1
pubmed: 32157465
Chen X, Sang N, Song K, et al. Psychomotor recovery following remimazolam-induced sedation and the effectiveness of flumazenil as an antidote. Clin Ther. 2020;42:614–24.
doi: 10.1016/j.clinthera.2020.02.006
pubmed: 32178858
Shida Y, Shida C, Hiratsuka N, Kaji K, Ogata J. High-frequency stimulation restored motor-evoked potentials to the baseline level in the upper extremities but not in the lower extremities under sevoflurane anesthesia in spine surgery. J Neurosurg Anesthesiol. 2012;24:113–20.
doi: 10.1097/ANA.0b013e318237fa41
pubmed: 22036875
Takayama A, Yamaguchi S, Ishikawa K, et al. Recovery of psychomotor function after total intravenous anesthesia with remifentanil-propofol or fentanyl-propofol. J Anesth. 2012;26:34–8.
doi: 10.1007/s00540-011-1266-5
pubmed: 22048284
Coskun D, Celebi H, Karaca G, Karabiyik L. Remifentanil versus fentanyl compared in a target-controlled infusion of propofol anesthesia: quality of anesthesia and recovery profile. J Anesth. 2010;24:373–9.
doi: 10.1007/s00540-010-0898-1
pubmed: 20229001
Choi JY, Lee HS, Kim JY, et al. Comparison of remimazolam-based and propofol-based total intravenous anesthesia on postoperative quality of recovery: a randomized non-inferiority trial. J Clin Anesth. 2022;82: 110955.
doi: 10.1016/j.jclinane.2022.110955
pubmed: 36029704
Mishra SK, Chandrasekaran A, Parida S, Senthilnathan M, Bidkar PU, Gupta SL. Time course of psychomotor recovery after intravenous dexmedetomidine infusion as a part of balanced anaesthetic technique: a randomised, double-blind study. Indian J Anaesth. 2019;63:623–8.
doi: 10.4103/ija.IJA_192_19
pubmed: 31462807
pmcid: 6691630
Dai G, Pei L, Duan F, et al. Safety and efficacy of remimazolam compared with propofol in induction of general anesthesia. Minerva Anestesiol. 2021;87:1073–9.
doi: 10.23736/S0375-9393.21.15517-8
pubmed: 34263581
Chen S, Wang J, Xu X, Zhang J, et al. The efficacy and safety of remimazolam tosylate versus propofol in patients undergoing colonoscopy: a multicentered, randomized, positive-controlled, phase III clinical trial. Am J Transl Res. 2020;12:4594–603.
pubmed: 32913533
pmcid: 7476156
Fan S, Zhu Y, Sui C, Li Q, Jiang W, Zhang L. Remimazolam compared to propofol during hysteroscopy: a safety and efficacy analysis. Pain Ther. 202312(3):695–706.
Pan Y, Chen M, Gu F, et al. Comparison of remimazolam-flumazenil versus propofol for rigid bronchoscopy: a prospective randomized controlled trial. J Clin Med. 2022;12:257.
doi: 10.3390/jcm12010257
pubmed: 36615057
pmcid: 9821250
Sato T, Mimuro S, Kurita T, et al. Recall of extubation after remimazolam anesthesia with flumazenil antagonism during emergence: a retrospective clinical study. J Anesth. 2022;36:688–92.
doi: 10.1007/s00540-022-03093-0
pubmed: 36076100
Yamamoto T, Kurabe M, Kamiya Y. Re-sleeping after reversal of remimazolam by flumazenil. J Anesth. 2021;35:322.
doi: 10.1007/s00540-021-02915-x
pubmed: 33687549
Masui K. Caution!! Reappearance of remimazolam effect after a flumazenil bolus: a larger bolus of flumazenil and a lower total remimazolam clearance are higher risks. J Anesth. 2023;37:1–5.
doi: 10.1007/s00540-022-03107-x
pubmed: 36114320
Takemori T, Oyama Y, Makino T, Hidaka S, Kitano T. Long-term delayed emergence after remimazolam-based general anesthesia: a case report. JA Clin Rep. 2022;8:86.
doi: 10.1186/s40981-022-00576-7
pubmed: 36260199
pmcid: 9582068
Parida S, Badhe AS. Comparison of cognitive, ambulatory, and psychomotor recovery profiles after day care anesthesia with propofol and sevoflurane. J Anesth. 2014;28:833–8.
doi: 10.1007/s00540-014-1827-5
pubmed: 24748400