Clinical Application Of Remimazolam Combined With Sevoflurane In General Anesthesia

Objective:To observe the clinical application effect of remimazolam combined with sevoflurane in general anesthesia.Methods:Select 40 cases of patients undergoing elective transurethral pelvic/ureteroscopic laser lithotripsy under general anesthesia,ASA gradeⅠ～Ⅲ,and randomly divide them into two groups,remimazolam group（group R）and propofol group（group P）,20 cases in each group.Group R:anesthesia induction,remimazolam6mg/（kg·h）+sufentanil 0.3μg/kg+rocuronium bromide 0.6mg/kg;anesthesia maintenance,remimazolam 0.5～1mg/（kg·h）+sevoflurane 0.4 minimum alveolar concentration（MAC）+remifentanil 0.1～0.15μg/（kg·min）.Group P:anesthesia induction,propofol 2mg/kg+sufentanil 0.3μg/kg+rocuronium bromide 0.6 mg/kg;anesthesia maintenance,propofol 2～4mg/（kg·h）+sevoflurane 0.4MAC+Remifentanil0.1～0.15μg/（kg·min）.Record before induction（T₀）,immediately after loss of consciousness（T₁）,immediately after intubation（T₂）,1 minute after intubation（T₃）,start of operation（T₄）,start of lithotripsy（T₅）,and 30 minutes after start of operation（T₆）,1 hour after the operation started（T₇）,end of lithotripsy（T₈）,awake（T₉）,extubation(T₁₀),1 minute after extubation(T₁₁)mean arterial pressure（mean arterial pressure,MAP）,heart rate（heart rate,HR）,EEG bispectral index（bispectral index,BIS）,sedation index（wavelet index,WLi）,EEG pain index（pain threshold index,PTi）,pain index（pain index,Pi）,delirium index（delirium index,DELi）,anxiety index（anxiety index,ANXi）,subcortical excitation index（Sc Ei）,cortical excitation index（cortical excitation index,CEi）,restlessness index（comfort index,CFi）,cognitive index（COGi）,pre-sleep index,forgetting index,left and right laterality,memory processing,brain energy consumption,inner focus,brain restraint,and brain inertia.The general data of the two groups of patients were recorded,including age,gender,height,weight,body mass index（BMI）,ASA classification,preoperative fasting time,preoperative total protein,albumin,and operation time.The incidence of injection pain during induction,the incidence of body movement,hiccup,and tearing during intubation were recorded in the two groups of patients.The waking time,operation time,and recovery room stay time of the patients in the two groups were recorded.The intraoperative hypertension,hypotension,tachycardia,bradycardia incidence and the dosage of metaraminol and atropine were recorded in the two groups of patients.The modified observer’s assessment of alert（MOAA/S）score,the Ricker sedation-agitation score（SAS）score and the visual analog scale（VAS）score after extubation were recorded in the two groups when they woke up.The incidences of postoperative nausea,vomiting,dizziness,headache and intraoperative awareness were recorded in the two groups.Results:（1）There was no significant difference in the general data between the two groups（P>0.05）.（2）There was no significant difference in the incidence of injection pain,body movement,hiccups,and tearing between the two groups（P>0.05）.（3）The incidence of hypotension and bradycardia,the dosage of atropine and metaraminol in group R were lower than those in group P（P<0.05）,but there was no significant difference in the incidence of hypertension and bradycardia between the two groups（P>0.05）.（4）The recovery time and extubation time of group R were longer than those of group P（P<0.05）,However,there was no significant difference in the length of stay in the resuscitation room between the R group and the P group（P>0.05）.（5）The MOAA/S score of group R was lower than that of group P（P<0.05）,But there was no significant difference in SAS score and VAS score between the two groups（P>0.05）.（6）There was no significant difference in the incidence of postoperative nausea,vomiting,dizziness,headache,and intraoperative awareness between the two groups（P>0.05）.（7）The MAP value of group R was higher than that of group P at T₁,T₂,T₃,T₉,and T₁₀（P<0.05）,and the HR value at T₂was higher than that of group P（P<0.05）.（8）At T₁,T₂,and T₃,the BIS value of group R was higher than that of group P,and at T₄,T₉,T₁₀,and T₁₁,the BIS value of group R was lower than that of group P,and the difference was statistically significant（P<0.05）.Conclusions:Remimazolam is safe and feasible for the induction and maintenance of general anesthesia.Compared with propofol,it has no injection pain,has less impact on the circulatory system,and can improve brain function.