Effects Of Remimazolam Benzenesulfonate On Cardiac Surgery Patients Hemodynamic Effects During The Induction Period Until Cardiopulmonary Bypass

Research backgroundPatients undergoing cardiovascular surgery such as coronary artery bypass,valve repair or replacement often have preoperative cardiac insufficiency,thus increasing the risk of general anesthesia.Hypotension after induction of general anesthesia is common due to the effects of vasodilation,sympathetic depression,and myocardial depression induced by anesthetic drugs,which can lead to inadequate intraoperative perfusion of vital organs and affect patient prognosis.Therefore,the selection of drugs for general anesthesia is particularly important,and the use of drugs that cause little hemodynamic disturbance to patients and maintain hemodynamic stability in patients after anesthesia can reduce postoperative mortality and the incidence of adverse events in patients.Existing studies suggest that the intravenous anesthetic remimazolam benzenesulfonate may be ideal for general anesthesia in patients undergoing cardiac surgery because of its low impact on the circulatory system,but such evidence is not yet sufficient;moreover,there is a lack of data on the extent of hemodynamic effects of remimazolam benzenesulfonate on patients undergoing such high-risk procedures,and the effects on organ function in patients undergoing cardiac surgery need to be further explored.Research purposeTo evaluate the effects of remimazolam benzenesulfonate when used as a general anesthetic sedative on the hemodynamics during the induction period of general anesthesia and the maintenance period before the start of extracorporeal circulation in patients undergoing elective cardiac surgery under cardiopulmonary bypass.Research methodsThis is a single-center,prospective,double-blind,randomized controlled study.Data from patients who underwent elective coronary artery bypass grafting with median incision under cardiopulmonary bypass,valve replacement or repair surgery,and coronary artery bypass grafting combined with valve replacement or repair surgery at Xijing Hospital between July 2022 and February 2023 were collected for analysis.During the study period,153 cases were screened,and 116 cases were finally included for analysis(58 cases each in the propofol and remimazolam benzenesulfonate groups).The primary outcome was the time-weighted value of mean arterial pressure(TWA-MAP)in patients with MAP measurements below baseline MAP measurements after induction of anesthesia until the start of extracorporeal circulation(observation period),which was analyzed using a general linear model.Secondary outcomes included the cumulative use of norepinephrine and epinephrine after induction of anesthesia and before the start of CPB,the incidence of severe bradycardia,the concentrations of serum inflammatory factors Including IL-6,TNF-α,brain cell damage markers Including NSE,S-100 B,HCY,and MD2,which were collected before induction of anesthesia and before the start of CPB,and the average power of each frequency wave of EEG after induction of anesthesia and before the start of CPB.ResultsThere was no statistically significant difference in TWA-MAP in remimazolam benzenesulfonate group compared to propofol group(25.61±9.52 mm Hg in the propofol group and 23.56±9.05 mm Hg in the remimazolam benzenesulfonate group,P=0.236).Among the secondary indicators,there was no statistically significant difference in the cumulative dose of norepinephrine used in the remimazolam benzenesulfonate group compared with the propofol group(40.90±42.46 μ g in the propofol group and39.82±57.17μg in the remimazolam benzenesulfonate group,P=0.909);there was also no statistically significant difference in the cumulative dose of epinephrine used in the two groups(6.62±30.36μg in the propofol group and 1.79±9.80μg in the remimazolam benzenesulfonate group,P=0.960);however,the incidence of severe bradycardia(heart rate <50 beats/min)was significantly lower in patients in the remimazolam benzenesulfonate group compared with the propofol group(19% vs.5.2%),a statistically significant difference(P=0.023).Among the serum factors,TNF-α,NSE,S-100 B and MD2,in both groups,had lower concentration levels at the moment of CPB onset than before induction(P < 0.05),but there was no statistical difference in the concentration levels of each serum factor between the two groups.The power values of gamma and theta oscillations of EEG in patients in the propofol group were statistically higher than those in the remimazolam benzenesulfonate group(P=0.004,P=0.001).ConclusionIn patients undergoing elective coronary artery bypass grafting under cardiopulmonary bypass,valve replacement or repair surgery,or coronary artery bypass grafting combined with valve replacement or repair surgery,the circulatory depressant effect of the intravenous anesthetic drug remimazolam benzenesulfonate was not statistically different from that of propofol in patients during the observation period(induction of general anesthesia to the start of extracorporeal circulation)of this study,nor was the vasoactive drug required in the two groups statistically.However,propofol was more likely to cause severe bradycardia in patients.Changes in brain injury markers and serum inflammatory factors also did not differ between the two groups.In conclusion,compared with propofol,the most commonly used intravenous anesthetic,remimazolam benzenesulfonate causes an approximate degree of intraoperative blood pressure drop in patients undergoing cardiac surgery,but a lower incidence of cardiovascular-related adverse events such as severe bradycardia.It is an alternative agent for intravenous anesthesia in patients undergoing cardiac surgery with high circulatory stability requirements.