Comparison Of The Sedative Effects Of Remazolam And Midazolam During Intravertebral Anesthesia

Objective To compare the sedative effects of remazolam and midazolam about intravertebral anesthesia.Methods The total of 60 patients,age 45-65,who were planning to undergo knee replacement surgery were randomly divided into remazolam groups and midazolam groups,30 cases in each group.After the patients entered the operating-room,we selected the lumbar3-lumbar4 for intraspinal anesthesia,a one-time infusion of 0.66% heavy ropivacaine lumbar anesthesia 2.5 ml with epidural catheterand then the block level became stable.Assist patients to recover supine position after spinal canal operation and oxygen inhalation,oxygen flow 4-6 L/min,after the block plane is stable,the sedative drug is given.The remazolam group(Group R)was given an intravenous injection of 0.1 mg/kg of remazolam,followed by continuous pumping of 5ug/kg/min continuous pump injection to BIS value decreased to 75,and then gradually adjust the infusion speed to maintain the BIS value between 60-80.Midazolam group(M group)was given a total of 0.05 mg/kg,and pumped 5 min to complete,followed by continuous pump injection of 0.05mg/kg/h continuous pump injection to BIS value decreased to 75,and then gradually adjust the infusion speed to maintain the BIS value between 60-80.During the operation,no other sedative and analgesic drugs were given,and the patients in both groups stopped pumping during the operation,and were sent to the PACU after conscious consciousness.Then record the time to reach the expected depth of sedation(from the start of administration to BIS<75),recovery time(time from end of pump injection to BIS>90),and when the anesthesia was stable(T0),after medication BIS<75(T1),operation begins20min(T2),stop the drug(T3),BIS>90% after withdrawal(T4)0respiratory rate(RR),mean arterial pressure(MAP),heart rate(HR),blood oxygen saturation(Sp O2)and count the incidence of adverse events.Results The results showed that compared with the M group,the time of reaching the expected sedation depth(BIS<75)and waking up(BIS>90)in the R group was shorter than that in the M group(P<0.01).Comparison of RR between groups at T2、T3 time points after medication,the RR of midazolam decreased significantly,the difference was statistically significant.Effect of the two groups on mean arterial pressure,the MAP of R group and M group decreased in T1、T2、T3 time,differences were statistically significant(P<0.05),but the degree of decline is still within the range of less than 20% of the base value,there was no significant difference in T4 time MAP T0 time between the two groups,MAP between the two groups was not statistically different.The two groups had no significant effect on HR.there was no statistically significant difference.The incidence of respiratory depression,irritability and postoperative delirium in M group was significantly higher than that in R groups,differences were statistically significant(P<0.05).Conclusion The use of remazolam toluenesulfonic acid(induction dose 0.1 mg/kg,pump dose 5 ug/kg/min)to assist sedation is safe and effective in knee arthroplasty with lumbar epidural anesthesia.Compared with midazolam,remazolam sulfonate had faster sedative onset and recovery time,lower frequency of hypoxemia and heart rate decrease,and no delirium irritability.