Clinical Study Of Remidazolam Combined With Alfentanil For Laryngeal Microsurgery In Elderly Objective

patientsTo observe the efficacy and safety of remazolam combined with different doses of alfentanil in anesthesia of laryngeal microsurgery in elderly patients.MethodsA total of 112 elderly patients（aged 65-75 years,weight 55-75 kg,ASA gradeⅠ-Ⅱ）were selected for laryngeal microsurgery.The patients were randomly divided into 4 groups（n=28 cases）: Propofol + Remifentanil Group（PR Group）and Remazolam + Alfentanil Group（RA₁ Group,RA₂ Group and RA₃ Group）.All patients were given total intravenous anesthesia.Induction of anesthesia: Remifentanil 1μg/kg,Propofol 1.5mg/kg and Mivacurium Chloride0.2mg/kg were injected intravenously in PR group;Alfentanil 15μg/kg,20μg/kg,25μg/kg,Remazolam 0.3mg/kg and Mivacurium Chloride 0.2mg/kg were injected intravenously in RA₁,RA₂ and RA₃ groups respectively.Anesthesia maintenance:PR group: Propofol(4⁶mg·kg^-1·h^-1)and Remifentanil(6¹0μg·kg^-1·h^-1);RA₁ group、RA₂ group and RA₃ group:Remazolam(0.5¹.5mg·kg^-1·h^-1)and Alfentanil（0.5².0μg·kg-1·min-1）.When the BIS value was less than or equal to 60,endotracheal intubation was performed.According to the BIS value of patients during operation,the dosage of anesthetic drugs can be adjusted at any time,BIS value is 45 55,and Mivacurium Chloride is intermittently given during operation to maintain muscle relaxation.MAP,HR and SpO₂ were recorded before entering the room（T₀）,after anesthesia induction（T₁）,1min after intubation（T₂）,1min after self-retaining laryngoscope（T₃）and 5min after extubation（T₄）.2ml of arterial blood was collected at T₀,T₂,T₃ and T₄,and the concentrations of serum epinephrine（E）,norepinephrine（NE）,C-reactive protein（CRP）and cortisol（Cor）were detected by Elisa method.;the incidence of cough response（FIC）and injection pain were recorded in 4 groups during induction of anesthesia;the recovery time and the time of leaving Pacu were recorded;the incidence of postoperative adverse reactions such as nausea and vomiting,restlessness in the awakening period and respiratory depression were recorded.The mini-mental state assessment（MMSE）and Montreal cognitive assessment scale（MOCA）were used to evaluate the cognitive ability of patients in 4 groups before and 24 and 48 hours after operation.ResultsThere was no significant difference in general clinical data between the 4groups（P>0.05）.Compared with T₀ time point,MAP and HR at T₁ time point in PR group decreased significantly,while MAP and HR at T₄ time point increased significantly（P<0.05）;MAP and HR were significantly increased at T₂ and T₃ in RA₁ group（P<0.05）;MAP and HR at T₁ in RA₃ group decreased significantly（P<0.05）;There was no significant change in SPO2 in each group（P>0.05）.Compared with T₀ time point,stress hormones E,NE,CRP and Cor at T₄ time point in PR group were significantly increased（P<0.05）;Stress hormones E,NE,CRP and Cor were significantly increased at T₂ and T₃ in RA₁ group（P<0.05）.There was no significant difference in preoperative MMSE and MOCA scores among the four groups（P>0.05）;Compared with PR group,the scores of MMES and MOCA in RA_1-2 group were significantly higher at 24 h after operation（P<0.05）.Compared with PR group,the time of full awake and time of leaving PACU in RA_1-2 groups were significantly shorter（P<0.05）;In RA₃ group,the time of full awake and the time of leaving PACU were significantly prolonged（P<0.05）.Compared with PR group,the incidence of FIC in RA_1-2 group was significantly lower（P<0.05）.Compared with PR group,Propofol injection pain in RA₁-3 group was significantly lower（P<0.05）Compared with PR group,the incidence of restlessness in recovery period was significantly lower in RA₂-3group（P<0.05）.ConclusionsRemazolam 0.3mg/kg and Alfentanil 20μg/kg were used for laryngeal microsurgery anesthesia in elderly patients,which could effectively inhibit cardiovascular reaction and release of stress hormones in perioperative patients,and did not affect the quality of recovery and cognitive ability,less adverse reaction after operation.