Application Of Remazolam Toluene Sulfonate In Gasless Laparoscopic Gynecologic Surgery

Objective:This project aims to study and explore the effects of remazolam tosylate for injection on respiratory,hemodynamics,body temperature,postoperative recovery and perioperative complications when applied to pneumoperitoneum-free laparoscopic gynecological surgery,in order to provide a reference for the clinical application of remazolam tosylate for injection.Method:One hundred and twenty patients（18～60 years old）who underwent elective pneumoperitoneum-free laparoscopic gynecological surgery in our hospital were selected,and eligible patients were divided into remazolam tosylate group（Remazolam,R group）,propofol group（Propofol,P group）,and sevoflurane group（Sevoflurane,S group）for inhalation according to the numerical random method,with 40 people in each group.In R group,0.3mg·kg^-1of remazolam tobenesulfonate was injected intravenously for induction of general anesthesia,sufentanil citrate 0.4ug·kg^-1 and cis-atracurium 0.2～0.3mg·kg^-1 were given respectively,and lidocaine hydrochloride 2%was injected into the larynx and intubated,remazolam 0.6～1mg·kg^-1·h^-1 and remifentanil 6～12ug·kg^-1·h^-1 were used in the operation.In P group,1.5～2mg·kg^-1of propofol was given intravenously to induce general anesthesia,sufentanil citrate 0.4ug·kg^-1 and cis-atracurium 0.2～0.3mg·kg^-1were given respectively,and lidocaine hydrochloride 2%was injected into the larynx and intubated,6～10mg·kg^-1·h^-1of propofol combined with 6～12ug·kg^-1·h^-1of remifentanil were infused by pump.S Group was induced by inhalation of 8%sevoflurane.When BIS decreased to 60,sufentanil citrate 0.4 ug·kg^-1 and cis-atracurium 0.2～0.3mg·kg^-1 were given in sequence,after 2%lidocaine hydrochloride injection was injected into the larynx,the tube was intubated and maintained with 1%～2%sevoflurane combined with remifentanil 6～12ug·kg^-1·h^-1 by pump.During the operation,the vital signs of the patient are closely monitored.If movement,frowning,swallowing or BIS>60 occurs,if appropriate,add remazolam 2.5～5mg or propofol 20～50mg or increase sevoflurane concentration until the body movements disappear or BIS≤60.Temperature（T）,Heart rate（HR）,Mean arterial pressure（MAP）,Pulse Oxygen Saturation（Sp O₂）were observed and recorded one minute before induction（T₀）,one minute after induction（T₁）,at the time of intubation（T₂）,at the beginning of Operation（T₃）,5 minutes before（T₄）and 5 minutes after skin suture（T₅）,the postoperative recovery,perioperative adverse reactions and total length of hospital stay were recorded,and the changes of evaluation indexes were followed up for 1～3 days.The statistical analysis uses SPSS 26.0 software to evaluate whether the measurement data belong to the normal distribution data according to the Shapiro-Wilk test method,and the measurement data that belong to the normal distribution are expressed by the mean±standard deviation（±SD）,the data that need to be measured repeatedly are analyzed by repeated measurement ANOVA,the comparison between the groups is based on Bonferroni analysis or LSD analysis,and the P value is automatically corrected by the SPSS software after the analysis.Non-normally distributed metrics are represented by median and upper and lower quartiles[M（P25,P75）],and the Kruskal walis rank sum test was used for between-group comparisons.Count data are expressed as examples or rates（%）,using chi-square test row-to-group comparisons.When P<0.05,the difference was statistically significant.The Technique for Order Preference by Similarity to Ideal Solution（TOPSIS）was used to systematically and comprehensively evaluate the T,HR,MAP,occurrence of perioperative adverse reactions,length of hospital stay and other indicators of all subjects.Result:There was no significant difference among the three groups in general data（such as mean age,sex,weight,BMI and length of operation）（P>0.05）.The time from the beginning of anesthesia to BIS≤60 and the time from the beginning of anesthesia to BIS≤60 were compared among the three groups.The time from the beginning of anesthesia to BIS≤60 in R group was significantly shorter than that in P group and S Group,the difference was statistically significant（P<0.05）.There was no significant difference in BIS before endotracheal intubation among the three groups（P>0.05）.At T₀ stage,there was no significant difference in body temperature among the three groups（P>0.05）.The body temperature in T₁～T₅ stage in P group was slightly lower than that in R Group,and that in T₄～T₅ stage in S group was slightly lower than that in R Group,the difference was statistically significant（P<0.05）.The temperature in T₂～T₅ stage of P Group was significantly lower than that in T₀stage,and that in T₃ stage of P Group was significantly lower than that in S group（P<0.05）.There was no significant difference in HR among the three groups at T₀ stage（P>0.05）.HR in T₁～T₃ stage R group was higher than that in P Group,HR in T₁～T₅ stage R group was slightly higher than that in S group,HR in T₂～T₅ stage R group was lower than that in T₀ stage R group,HR in T₁～T₅stage R group was slightly lower than that in T₀ stage P Group and S Group,the difference was statistically significant（P<0.05）.HR in T₅ stage in P group was significantly higher than that in S group（P<0.05）.There was no significant difference in MAP among the three groups at T₀ stage（P>0.05）.MAP in T₁～T₃stage R group was higher than that in P Group,MAP in T₂～T₅ stage R group was higher than that in S Group,MAP in T₁～T₃ stage and P Group was lower than that in T₀ stage,MAP in S group was lower than that in T₁～T₅ stage,the difference was statistically significant（P<0.05）.MAP in T₃～T₄ stage of P Group was higher than that in S group（P<0.05）.The recovery of R Group and S group were faster than that of P group,and the stay time of PACU in S group was shorter than that in P group（P<0.05）.Statistical data showed that there was no significant difference in the total length of stay among the three groups（P>0.05）.There was no significant difference in the incidence of hypoxemia and hypertension among the three groups（P>0.05）.The incidence of hypotension in R group was significantly lower than that in P group and S group.The incidence of bradycardia and injection pain in R group and S group were significantly lower than that in P group.the incidence of nausea and vomiting in R group was significantly higher than that in S Group,the difference was statistically significant（P<0.05）.Results of TOPSIS entropy weight comprehensive score:R Group>S group>P group.Conclusion:Compared with propofol and sevoflurane inhalation in general anesthesia for single-port laparoscopic gynecologic surgery without pneumoperitoneum,remazolam tobesilate injection was used for induction and maintenance of general anesthesia.The induction and recovery of the patients were faster,the effects of respiration and hemodynamics during the operation were less,and the adverse reactions during the perioperative period were less,it is worthy of clinical application.