Comparison of the Incidence of Postoperative Acute Kidney Injury Following the Administration of Remimazolam or Sevoflurane in Elderly Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial

Lee, S.; Kang, Hyungsook; Ahn, Ye Na; You, Ann Hee

doi:10.3390/jpm13050789

Cited by 6 publications

(9 citation statements)

References 45 publications

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“…In a previous study, the time to extubation after cessation of remimazolam decreased to a value comparable to that after sevoflurane cessation. [20] There was a previous study by Sekiguchi et al [21] comparing remimazolam and propofol during the induction of anesthesia in middle-aged and elderly patients, and no significant difference of hemodynamics were observed between those who administered remimazolam and propofol. There are several difference between the study by Sekiguchi et al and this study.…”

Section: Discussionmentioning

confidence: 89%

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Incidence of intraoperative hypotension in older patients undergoing total intravenous anesthesia by remimazolam versus propofol: A randomized controlled trial

Jeon,

Kim,

Park

et al. 2023

Medicine

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Background: An increase in the frequency of surgeries among older individuals is observed in some countries. Hypotension is common and exaggerated in older patients and can lead to increased morbidity and mortality. Total intravenous anesthesia is commonly administered with propofol, while remimazolam has been suggested as an alternative to propofol because of advantages such as a more stable hemodynamic profile and less respiratory suppression. We conducted a single-blind, parallel-group randomized controlled trial to compare the incidence of intraoperative hypotension between patients administered with remimazolam and propofol. Methods: A total of 132 patients, aged between 65 to 80 years and undergoing laparoscopic cholecystectomy or transurethral resection of bladder tumors were randomly assigned to the propofol or remimazolam group with a permuted block system while being blinded to the hypnotic agent. Remifentanil was administered via target-controlled infusion in both groups, with an initial effect-site concentration of 3.0 ng/mL and titration range of 1.5 to 4.0 ng/mL intraoperatively. The primary outcome of this study was the overall incidence of hypotension during general anesthesia. Results: Patients in the propofol group experienced higher intraoperative hypotension than those in the remimazolam group (59.7% vs 33.3%, P = .006). Multivariate logistic regression analysis showed that remimazolam administration was associated with reduced hypotension (adjusted odds ratio, 0.34; 95% CI, 0.16–0.73). Secondary outcomes such as recovery time, delirium, and postoperative nausea and vomiting were comparable in both groups. Conclusion: Total intravenous anesthesia with remimazolam was associated with less intraoperative hypotension than propofol in older patients, with a comparable recovery profile.

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Section: Discussionmentioning

confidence: 89%

“…In a previous study, the time to extubation after cessation of remimazolam decreased to a value comparable to that after sevoflurane cessation. [ 20 ]…”

Section: Discussionmentioning

confidence: 99%

Incidence of intraoperative hypotension in older patients undergoing total intravenous anesthesia by remimazolam versus propofol: A randomized controlled trial

Jeon,

Kim,

Park

et al. 2023

Medicine

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“…Several studies have reported DEX-induced bradycardia ( 46 , 47 ). Studies have also reported that there is less reduction in HR when RMMZ is administered than that with the administration of other anesthetic drugs ( 48 , 49 ). Similar results were obtained in the present study.…”

Section: Discussionmentioning

confidence: 99%

Comparison of oxygen reserve index according to the remimazolam or dexmedetomidine for intraoperative sedation under regional anesthesia—A single-blind randomized controlled trial

Lee,

Kim,

Kang

et al. 2023

Front. Med.

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IntroductionWe aimed to evaluate the difference in intraoperative oxygen reserve index (ORi) between the sedatives remimazolam (RMMZ) and dexmedetomidine (DEX).MethodsSeventy-eight adult patients scheduled for sedation under regional anesthesia were randomly assigned to either the DEX (n = 39) or RMMZ (n = 39) group. The primary outcome was the difference in perioperative ORi between the groups. The secondary outcomes included respiratory depression, hypo- or hypertension, heart rate (HR), blood pressure, respiratory rate and postoperative outcomes. Additionally, the number of patients who experienced a decrease in intraoperative ORi to < 50% and the associated factors were analyzed.ResultsThe ORi was significantly higher in the RMMZ group at 15 min after sedation maintenance. There were no significant differences in respiratory depression between the two groups. The intraoperative HR was significantly higher in the RMMZ group after the induction of sedation, 15 min after sedation maintenance, and at the end of surgery. No other results were significantly different between the two groups. The incidence of a decrease in intraoperative ORi to < 50% was significantly higher in the DEX group. Factors associated with a decrease in the intraoperative ORi to < 50% were diabetes mellitus, low baseline peripheral oxygen saturation (SpO2), and DEX use. In the receiver operating characteristic curve analysis for a decrease in the intraoperative ORi to < 50%, the cutoff baseline SpO2 was 97%.ConclusionRMMZ is recommended as a sedative for patients with a low baseline SpO2 and intraoperative bradycardia. Further studies should be conducted to establish the criteria for a significant ORi reduction.

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“…Following the removal of 35 duplicate records through automated and manual methods, an additional 41 records were excluded after reviewing their titles and abstracts, as they did not meet the inclusion criteria. Upon reviewing the full-text articles of the remaining records, we excluded 13 studies for various reasons: they were not randomized controlled trials [32][33][34][35][36][37], did not set up a propofol group [38,39], did not have routine flumazenil usage in the remimazolam group [19,[40][41][42], or did not have outcomes we wanted [43]. Ultimately, nine studies meeting the criteria were included [44][45][46][47][48][49][50][51][52].…”

Section: Search and Selectionmentioning

confidence: 99%

Comparison of Remimazolam–Flumazenil versus Propofol for Recovery from General Anesthesia: A Systematic Review and Meta-Analysis

Wu,

Xu,

Wang

et al. 2023

JCM

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(1) Purpose: to systematically evaluate the recovery following sedation and anesthesia with remimazolam combined with flumazenil in comparison to propofol. (2) Methods: Electronic databases, including PubMed, Embase, Web of Science, and the Cochrane Library, were systematically searched from their inception up to 22 October 2023. Included in this analysis were randomized controlled trials (RCT) that compared remimazolam–flumazenil with propofol for the recovery from sedation and anesthesia in adults. The risk of bias was assessed using the Cochrane risk of bias tool. Pooled risk ratios (RR) or mean differences (MD) along with their corresponding 95% confidence intervals (CI) were calculated using either fixed-effects or random-effects models, and the results were visualized in forest plots. (3) Results: Nine RCTs involving 745 patients who underwent general anesthesia in three different countries were included. Compared to propofol, the remimazolam–flumazenil combination shortened the emergence time (MD = −4.34 min, 95% CI = [−6.88, −1.81], p = 0.0008, low certainty), extubation time (MD = −4.26 min, 95% CI = [−6.81, −1.7], p = 0.0011, low certainty), and the post-anesthesia care unit (PACU) stay (MD = −4.42 min, 95% CI = [−7.45, −1.38], p = 0.0044, low certainty), while reducing the incidence of respiratory depression (RR = 0.2, 95% CI = [0.04, 0.89], p = 0.03, high certainty) after general anesthesia. However, this combination was associated with a higher incidence of re-sedation (RR = 4.15, 95% CI = [1.31, 13.13], p = 0.01, moderate certainty). (4) Conclusions: Based on the existing evidence, the combination of remimazolam and flumazenil accelerates recovery from general anesthesia and lowers the risk of respiratory depression compared to propofol. However, it is important to consider the higher risk of re-sedation when using this combination in clinical practice. Due to limitations in the quality of the evidence, it is advisable to interpret the results of meta-analyses with caution.

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Comparison of the Incidence of Postoperative Acute Kidney Injury Following the Administration of Remimazolam or Sevoflurane in Elderly Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial

Cited by 6 publications

References 45 publications

Incidence of intraoperative hypotension in older patients undergoing total intravenous anesthesia by remimazolam versus propofol: A randomized controlled trial

Incidence of intraoperative hypotension in older patients undergoing total intravenous anesthesia by remimazolam versus propofol: A randomized controlled trial

Comparison of oxygen reserve index according to the remimazolam or dexmedetomidine for intraoperative sedation under regional anesthesia—A single-blind randomized controlled trial

Comparison of Remimazolam–Flumazenil versus Propofol for Recovery from General Anesthesia: A Systematic Review and Meta-Analysis

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