Application Of Remimazolam Combined With Propofol In Endoscopic Sinus Surgery Under General Anesthesia

Objective:To investigate the effect of using remimazolam in combination with propofol in general anesthesia for endoscopic sinus surgery（ESS）.Methods:Eighty patients scheduled to undergo ESS under general anesthesia were enrolled and randomly divided into the remimazolam-propofol group（RM group,n=40）and the Propofol group（C group,n=40）.After the patients entered the operating room,blood pressure,ECG and other vital signs were routinely monitored.The RM group received a 5 mg loading dose of remimazolam during the induction period,followed by1.5～2.5mg/kg propofol,0.3μg/kg sufentanil,and 0.15mg/kg cis-atracurium in sequence.Continuous intravenous pumping of remimazolam0.3mg/（kg·h）,propofol 2～10mg/（kg·h）,remifentanil 0.1～0.2μg/（kg·min）and inhalation of 1%sevoflurane in the RM group during the maintenance period.In group C,the equivalent amount of saline was used instead of remimazolam,and the usage and dosage of other drugs in the induction and maintenance periods and related operations were exactly the same as in group RM.Intraoperative BIS values were maintained at 40～60 by adjusting the pump rate of propofol and remifentanil in both groups.Dezocine injection 5 mg and ondansetron 4 mg were injected intravenously30 minutes before the end of the operation.Intraoperative vital signs were monitored and mean arterial pressure（MAP）and heart rate（HR）were recorded at 5 minutes after admission（T1）,1 minute before intubation（T2）,immediately after intubation（T3）,3 minutes after intubation（T4）,on awakening（T5）,immediately after extubation（T6）,and 10 minutes after extubation（T7）;Recording the baseline BIS values in both groups after entering the operating room,comparing the time taken from anaesthetic administration to a BIS value of less than 60,duration of surgery,duration of anaesthetic administration,total intraoperative propofol and remifentanil consumption in both groups,the recovery time and PACU residence time,volume of fluid infused during surgery,intraoperative blood loss;Record perioperative choking cough during induction,injection pain,intraoperative body movements,intraoperative awareness,delirium and agitation during the waking period,PONV,POCD,hypotension,hypertension,bradycardia,tachycardia,low SPO₂ and any other adverse events that occur;The Steward awakening score before transfer out of the PACU and the patient satisfaction score with this anesthesia were compared.Results:1.There is no statistical difference in the basic conditions of the two groups compared to each other（P>0.05）.2.Hemodynamic indexes:In terms of MAP,the RM group was higher than the C group before and after intubation during the induction period（T2,T3,T4）and lower than the C group immediately after extubation（T6）,with statistically significant differences（P<0.05）.In terms of HR,1 minute before intubation（T2）and immediately after intubation（T3）were higher in the RM group than in the C group,and the difference was statistically significant（P<0.05）.3.The RM group had faster sedation and less intraoperative propofol and remifentanil consumption,but longer awakening time and PACU stay,the difference was statistically significant（P<0.05）.4.No adverse reactions such as severe respiratory circulation disturbance,intraoperative body movement,intraoperative awareness,delirium or agitation during recovery,PONV and POCD occurred in group C and RM.Compared with group C,the incidence of perioperative choking cough,injection pain,hypotension,bradycardia and low pulse oxygen saturation was lower in group RM,and the difference was statistically significant（P<0.05）.5.Compared with group C,the RM group had higher Steward recovery score and higher patient satisfaction score after surgery,and the differences were statistically significant（P<0.05）.Conclusion:Compared with propofol alone,remimazolam combined with propofol induced faster sedation,less injection pain and cough reflex,more stable perioperative vital signs,lower incidence of perioperative adverse events,less consumption of propofol and remifentanil while meeting the demand of anesthesia,higher recovery quality and patient satisfaction after surgery.These results suggest that the anaesthetic effect of remimazolam combined with propofol is superior to that of propofol alone in ESS,which is suitable for popularisation and application in ESS.