Study On Administration Methods Of Remimazolam And Its Effect On Heart Rate Variability

Part I Effects of two administration methods of remimazolam on haemodynamics and sedative effect Purpose: Observing the difference between two administration methods of remimazolam on haemodynamics,sedation effect and adverse reaction,evaluating the viability of continuous infusion-pumped remimazolam and providing reference basis for its clinical medication.Method: Sixty patients undergoing selective operation in our hospital were selected from June to August 2020.Patients were divided into two groups using a random number table method including discontinuous intravenous-injected group(group I)and continuous infusion-pumped group(group P),with thirty cases in each group.After intravenously injecting remimazolam 5.0 mg for two groups,patients in the group I were intermittently injected with remimazolam to maintain the depth of sedation,and patients in the group P were continuously injected with remimazolam to maintain the sedation depth within 15 minutes.The systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)and bispectral index(BIS)were recorded in observation period.After administration,the standard deviation of BIS continuous data of patients was used as a statistical index of the degree of dispersion to evaluate the fluctuation of sedation depth and the stability of anesthesia.Meanwhile,the dosage of drugs and the occurrence of adverse reactions were recorded and compared between two groups.Results: After the infusion,SBP and DBP in two groups were significantly decreased,with statistical difference compared with 0 min(P < 0.05).SBP in group I was significantly lower than group P,the difference was statistically significant(P < 0.05).HR in group I increased in 2-15 min,and HR in group P increased at 2 min and 3 min,with statistical difference compared with 0 min(P < 0.05).HR in group I was higher than group P in 3-15 min,with statistical difference(P < 0.05).BIS in two groups showed a declined trend,and the difference of BIS between 1-15 min compared with 0min was statistically significant(P < 0.05).BIS in group I was higher than group P at 1min,11 min and 12 min,and lower than group P at 4 min,with statistical difference(P< 0.05).The drug dosage and BIS continuous data of the degree of dispersion in group P were less than group I,with statistical difference(P < 0.05).There were no significant difference in the incidence of adverse reactions between two groups(P > 0.05).Conclusions:(1)Compared with discontinuous intravenous-injected,continuous infusion-pumped remimazolam has a slight effect on haemodynamics.(2)Compared with discontinuous intravenous-injected,continuous infusion-pumped remimazolam can reduce the dosage of drugs.(3)Compared with discontinuous intravenous-injected,the degree of BIS dispersion for continuous infusion-pumped remimazolam is lower,and its sedative effect is more stable.Part II Effect of continuous infusion-pumped remimazolam on heart rate variability Purpose: Observing the effects of continuous infusion-pumped remimazolam on the sedation effect and heart rate variability,and comparing it with the classic sedative drugs dexmedetomidine and midazolam,providing reference basis for sedative method.Method: Ninety patients undergoing selective operation in our hospital were selected from September 2020 to February 2021.Patients were divided into three groups using a random number table method including remimazolam group(group A),dexmedetomidine group(group B)and midazolam group(group C),with thirty cases in each group.These three groups were pumped with drugs for 15 minutes.After intravenously infusing remimazolam 5.0 mg for group A,patients in group A were continuously pumped with remimazolam 0.125 mg/kg,patients in group B were continuously pumped with dexmedetomidine 0.5 μg/kg,and patients in group C were continuously pumped with 0.06 mg/kg midazolam.The HR,mean arterial pressure(MAP),pulse oxygen saturation(Sp O2),the observer’s assessment of alertness/sedation(OAA/S)scale,BIS and heart rate variability(HRV)including low frequency power(LF),high frequency power(HF)and the balance ratio of sympathetic to vagal tone (LF/HF)were recorded before the infusion(T0),5 minutes after the infusion(T1),10 minutes after the infusion(T2),15 minutes after the infusion(T3).Meanwhile,the incidence of adverse reactions in the three groups was recorded during the observation period.Results: Compared with T0,HR of group A increased at T1,HR of group B and group C at T2 and T3 was significantly decreased,and HR of group B at T2 was significantly lower than group A,HR of group B at T3 was significantly lower than group A and group C,the difference was statistically significant(P < 0.05);MAP in three groups were apparently decreased at T1,T2 and T3,with statistical difference(P < 0.05);the OAA/S score and BIS of the three groups were significantly decreased at T1,T2 and T3,the differences were statistically significant(P < 0.05);LF of group A,group B and group C at T1,T2 and T3 decreased,and LF of group A at T1 and T2 was significantly lower than group B,with statistical difference(P < 0.05);HF of group A at T1、T2 and T3,group C at T2 and T3 decreased,and HF of group B increased at T1,T2 and T3,with statistical difference(P < 0.05);LF/HF of group B decreased at T2 and T3,which was significantly lower than group A and group B,and the difference was statistically significant(P < 0.05).Conclusions:(1)Continuous infusion-pumped remimazolam can be used as a preoperative sedative.(2)Continuous infusion-pumped remimazolam can slightly decrease blood pressure of patients and cause heart rate temporary mild increase.(3)At the same sedation level,remimazolam,dexmedetomidine and midazolam have different effect on heart rate variability.Remimazolam can decrease LF and HF,and it does not significantly change the balance between LF and HF.