Clinical Observation Of Remimazolam Tosilate In General Anesthesia Of Elderly Patients Undergoing Endoscopic Retrograde Cholangiopancreatography

Objective:At present,most of the clinical short-term surgical anesthesia is based on intravenous anesthesia,but traditional intravenous anesthesia sedative drugs are not ideal drugs in the elderly patients.Remimazolam is an ultra-short-acting intravenous benzodiazepine sedative drug,which has the advantages of rapid onset,short action time and recovery time,small circulation fluctuation,no injection pain,and little accumulation after long-term infusion.Remimazolam is mostly used for programmed sedation and general anesthesia in adults under 60 years of age,but its application research in elderly patients is still less.The purpose of this study is to observe the effect of remimazolam on the induction and maintenance of general anesthesia in elderly ERCP patients,so as to provide evidence basis for its application in elderly patients.Methods:The elderly patients who were scheduled to undergo ERCP under general anesthesia from June 2021 to June 2022,age≥65 years old,gender unlimited,BMI18-30 kg/m~2,ASA grade Ⅰ-Ⅱ.Divide patients into two groups based on whether they have hypertension before surgery:group A had hypertension(n=56),and group B had no hypertension(n=54).Two groups of anesthesia induction schemes:intravenous infusion of remimazolam 0.3mg/kg,and intravenous infusion of alfentanil 20ug/kg,rocuronium 0.60 mg/kg when 45≤BIS≤60.Anesthesia maintenance plan:continuously pump 1 mg/(kg·h)of remimazolam and 0.2 ug/(kg·min)of remifentanil,and change the drug infusion rate during the operation to make the BIS value within the range of 40-60.10 minutes before the end of the operation,the dosage of intravenous drug was reduced by 20%,and the drug was stopped after the operation.Record the anesthesia induction time of the two groups(from the beginning of induction to BIS≤60).Record systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)before induction(T0),before endotracheal intubation(T1),at the time of endoscopic insertion(T2),5 minutes after endoscopic insertion(T3),and at the end of surgery(T4).Record the number of vasoactive drugs used.Record the awakening time and Ramsay sedation score immediately after extubation.The MMSE cognitive function scores of patients were recorded before operation,72 hours after operation and30 days after operation.Record the incidence of injection pain,adverse reactions and intraoperative awareness.Results:Finally,110 patients were included in the analysis.The general data and surgical related conditions(operation time,dosage of remimazolam)of the two groups were evenly distributed among the groups,and the difference was not statistically significant(P>0.05).Systolic blood pressure,diastolic blood pressure and heart rate in group A decreased at T1-T4,and the difference was statistically significant(P<0.05).The systolic blood pressure and heart rate of group B decreased at T1-T4,with significant difference(P<0.05).There was no significant difference in diastolic blood pressure(P>0.05).The degree of reduction of systolic and diastolic blood pressure in group A was higher than that in group B,with statistical difference between groups(P<0.05).There was no significant difference in the amplitude of heart rate change between the two groups(P>0.05).There were 28 patients in Group A and 5 patients in Group B who needed to use vasopressor drugs.The number of patients in Group A was higher than that in Group B,and the difference was statistically significant(P<0.05).There was no significant difference in induction time and awakening time between the two groups(P>0.05).There was no significant difference in Ramsay sedation score between the two groups immediately after extubation(P>0.05).There was no significant difference in MMSE cognitive function scores between the two groups at 72hours and 30 days after operation(P>0.05).There was no significant difference in the occurrence of adverse reactions between the two groups(P>0.05).Both group A and group B achieved good satisfaction with surgeons and patients,and there was no significant difference between the two groups(P>0.05).No injection pain occurred in both groups,and no intraoperative awareness and serious adverse events were observed.Conclusions:Remimazolam at an induction dose of 0.3mg/kg and a maintenance dose starting at 1mg/(kg·h)can be safely and effectively used in healthy elderly patients during short-term surgery without significant circulation inhibition.