Application Of Remazolam Toluene Sulfonate Combined With Paravertebral Nerve Block In Thoracoscopic Lobectomy Under Sedline Monitoring

Objective:To explore the clinical value of remiazolam mesylate combined with thoracic paravertebral nerve block（TPVB）in thoracoscopic lobectomy under the monitoring of SEDline sedation monitor.Methods:From June 2021 to May 2022,80 patients（45 males and 35 females,aged 40-71 years）who underwent thoracoscopic lobectomy in the First Affiliated Hospital of Bengbu Medical College were included.80 patients were randomly divided into 4groups by using the numerical table method.Among them,remiazolam mesylate intravenous anesthesia combined with TPVB was used as the TR group,remiazolam mesylate intravenous anesthesia was used as the R group,propofol intravenous anesthesia combined with TPVB was used as the TB group,and propofol intravenous anesthesia was used as the B group,with 20 patients in each group.All patients underwent thoracoscopic lobectomy under the monitoring of SEDline sedation monitor.During the operation,the anesthetic dosage was adjusted according to the patient’s brain state index（PSI）,and the PSI was maintained at 25～50.Observation indexes:（1）The clinical baseline data of the four groups,including gender,age,body mass index（BMI）,preoperative serum homocysteine（Hcy）,preoperative cognitive function score of the Mini Mental State Examination（MMSE）,were compared;（2）Percutaneous arterial oxygen saturation（SPO₂）,heart rate,mean arterial pressure（MAP）,and serum malondialdehyde（MDA）and advanced oxidation protein product（AOPP）were recorded and compared before anesthesia induction（T0）,at skin incision（T1）,30minutes of one lung ventilation（T2）,and immediately after operation（T3）in the four groups;（3）The operation time,intraoperative infusion volume,bleeding volume and remifentanil hydrochloride dosage of the 4 groups were recorded and compared;（4）The visual analogue scale（VAS）score of pain and Ramsay sedation score at 6 and 24hours after operation were compared,and the serum Hcy level,MMSE cognitive function score,and the times of pressing analgesia pump at 24 hours after operation were compared.Results:（1）There was no significant difference in the clinical baseline data such as gender,age,BMI,preoperative Hcy,preoperative MMSE score among the four groups（all P values>0.05）.（2）Comparison of indexes at different time points in the group:the heart rate of group R was significantly different at different time points（F=3.30,P=0.025）,while the heart rate of group TR,TB and B was not significantly different at different time points（all P values>0.05）;MAP,SPO₂,MDA and AOPP in the four groups were significantly different at different time points（all P values<0.05）.Comparison between groups at different time points:At T0,there was no significant difference in MAP,heart rate,SPO₂,MDA and AOPP among the four groups（all P values>0.05）.At T1 and T2,the difference of heart rate,MDA and AOPP was statistically significant（all P values<0.05）.The heart rate of TB group was the lowest,while that of TR group was the lowest;There was no significant difference in MAP and SPO₂（all P values>0.05）.At T3,there was no significant difference in MAP,MDA and AOPP（all P values>0.05）.MAP in group B was the lowest,while MDA and AOPP in group TR were the lowest;There was no significant difference in heart rate and SPO₂（all P values>0.05）.（3）The dosage of remifentanil hydrochloride during operation in the four groups was less in TR group and TB group,but more in R group and B group,with a statistically significant difference（F=23.67,P<0.001）;The operation time and intraoperative infusion volume.There was no significant difference in the amount of bleeding（all P values>0.05）.（4）There was no significant difference between the four groups in terms of pain VAS score and Ramsay sedation score 6 and 24 hours after operation,as well as the level of serum Hcy,MMSE cognitive function score and the number of times of pressing analgesia pump 24 hours after operation（all P values>0.05）.Conclusions:Under the monitoring of SEDline sedation monitor,remiazolam toluenesulfonate combined with TPVB can more accurately control the anesthesia state during thoracoscopic lobectomy,and the patient’s circulation fluctuation range is small,so the sedation and analgesia effects after operation are more advantageous.In addition,it can reduce the incidence of postoperative restlessness and help patients recover quickly after surgery.