Application effects of remimazolam and propofol on elderly patients undergoing hip replacement

Abstract

Objective To explore the anesthetic and analgesic effects of remimazolam and propofol in elderly patients undergoing hip replacement and their effects on respiratory and circulatory systems, stress and cognitive function. Methods Sixty elderly patients undergoing elective hip replacement in the hospital were selected as the research subjects, and they were divided into the remimazolam group and the propofol group according to the admission sequence of patients. The remimazolam group was anesthetized with remimazolam, and the propofol group was anesthetized with propofol. The anesthesia-related indicators, perioperative pain degree [Visual Analogue Scale (VAS)], circulatory indicators [heart rate, mean arterial pressure (MAP)] before anesthesia (T0), immediately before laryngeal mask insertion (T1), at 5 min after laryngeal mask insertion (T2), at 30 min after laryngeal mask insertion (T3) and at 5 min after laryngeal mask removal (T4), stress response indicators (plasma epinephrine, norepinephrine, cortisol) before anesthesia induction and at 24 h and 72 h after surgery, cognitive function [Mini-Mental State Examination (MMSE)] and adverse reactions were compared between the two groups. Results Among the 60 enrolled patients, only 1 case was excluded due to withdrawal, thus 30 cases in the remimazolam group and 29 cases in the propofol group were included. There were statistically significant differences in the heart rate, MAP, plasma epinephrine, norepinephrine, cortisol and VAS score in the two groups from the aspects of interaction effect and time-point effect (P < 0.05). The heart rate and MAP at T1, T2 and T3 in the two groups were significantly decreased compared with those at T0, but the heart rate and MAP in the remimazolam group at T1, T2 and T3 were significantly higher than those in the propofol group (P < 0.05). There were no statistical differences in the anesthesia time, awakening time and extubation time between the remimazolam group and the propofol group (P > 0.05). The levels of plasma epinephrine, norepinephrine and cortisol in the two groups were significantly higher at 24 h and 72 h after surgery than those before anesthesia induction, and the above levels were significantly lower in the remimazolam group than those in the propofol group (P < 0.05). The VAS scores at each time point in the two groups were significantly reduced compared to before surgery, but there was no statistically significant difference between the two groups after surgery (P > 0.05). The MMSE scores of the two groups were significantly lower at 1 d and 3 d after surgery compared with those before anesthesia induction, but the score in the remimazolam group was significantly higher than that in the propofol group (P < 0.05). In addition, the incidence rates of adverse reactions were significantly lower in the remimazolam group compared to the propofol group (P < 0.05). Conclusion Compared with propofol, remimazolam can achieve equivalent anesthetic and analgesic effects in elderly patients undergoing hip replacement. However, the latter one can significantly relieve respiratory and circulatory suppression, stress response and cognitive dysfunction, with good safety. Trial registration This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 31/12/2021 with the registration number ChiCTR2100055039.

Remimazolam-based anesthesia in a patient with hypertrophic obstructive cardiomyopathy undergoing radical colorectal cancer surgery: A case report

“…This may be because remimazolam can act on adrenergic receptors, inhibit norepinephrine release, and reduce the catecholamine level as well as sympathetic nerve excitability, however remimazolam can accelerate atrioventricular conduction and enhance myocardial contractility. [8] The use of esmolol is ideal for suppressing sympathetic stimulation, thereby decreasing the LVOT gradient and improving the cardiac output. [9] The DoA was monitored using CFSi based on electroencephalogram in this patient.…”

Comparison of the effects of remimazolam tosylate and propofol on postoperative delirium among older adults undergoing major non-cardiac surgery: protocol for a randomised controlled trial

“…Total intravenous anaesthesia with remimazolam tosylate causes minimal haemodynamic and respiratory depression in elderly patients. Compared with propofol, remimazolam tosylate may have an equivalent anaesthetic effect and a higher safety profile for elderly patients undergoing hip replacement, gastrointestinal endoscopy, bronchoscopy and general anaesthesia 56–58. Moreover, previous literature has also proven remimazolam tosylate’s availability as a general anaesthetic for continuous infusions during procedures longer than 2 hours 59.…”

“…Compared with propofol, remimazolam tosylate may have an equivalent anaesthetic effect and a higher safety profile for elderly patients undergoing hip replacement, gastrointestinal endoscopy, bronchoscopy and general anaesthesia. 56–58 Moreover, previous literature has also proven remimazolam tosylate’s availability as a general anaesthetic for continuous infusions during procedures longer than 2 hours. 59 However, research on the effect of remimazolam tosylate on the incidence of POD is very limited.…”

Safety and efficacy of remimazolam for general anesthesia in elderly patients undergoing laparoscopic cholecystectomy: a randomized controlled trial

“…Several studies have shown that remimazolam is safer than propofol in terms of stable hemodynamic changes (1,4,5,9). Compared with propofol, remimazolam has the advantage of preventing hypotension during the induction of anesthesia and similar anesthetic effects in elderly patients (10,11). However, there is insufficient evidence regarding the efficacy and safety of remimazolam in elderly patients, and it is unknown whether remimazolam can be used safely and effectively in elderly patients at the clinical doses proposed by manufacturers.…”