Effects Of Remazolam And Propofol On Sublagal Microcirculation During Anesthesia Induction In Patients Undergoing Off-pump Coronary Artery Bypass Grafting

Background:Microcirculation refers to the blood circulation between arterioles and venules,which is the main place for material exchange between human blood and tissue cells.Maintaining microcirculation perfusion is crucial to the stability of organ function.Current studies have shown that microcirculation disorder is correlated with organ dysfunction and patient survival rate During anesthesia,the change of microcirculation activity can have a direct impact on tissue and organ perfusion,reduce the postoperative recovery rate of patients,and delay the total length of hospitalization whether sublingual microcirculation can reflect the change of systemic organ microcirculation,but existing studies have shown that when abdominal pressure<At 10 mm Hg（1mm Hg=0.133k Pa）,the microcirculation changes of the sublingual mucosa and gastrointestinal tract were almost the same.Therefore,monitoring the microcirculation changes of the sublingual mucosa can indirectly reflect the changes of the internal microcirculation.Propofol is a common clinical intravenous anesthetic sedative,and propofol has the characteristics of quick effect and short action time It can be rapidly redistributed between brain and terminal metabolism,mainly through the formation of glucuronic acid complex or oxide metabolism in liver via CYP2B6 enzyme Ramazolam is a new benzodiazepine drug,which belongs to ultra-short-acting sedative/anesthetic drugs.By binding to the BZ receptor site on the surface of GABA_A receptor complex,it causes conformational changes of the receptor,promotes the binding of GABA and GABA_A receptor,improves the frequency of Cl^-channel opening,enhances the internal flow of Cl^-,and thereby causes central inhibitory effects Remazolam benzoate is characterized by rapid maintenance and short recovery time,not easy accumulation of metabolism on liver and kidney function without serious side effects,and can be developed clinically for the use of sedation in therapeutic and diagnostic operations,induction and maintenance of general anesthesia and ICU sedation,how to monitor the microcirculation,is an urgent problem to be solved at present At present,the methods for monitoring microcirculation in clinical work mainly include:judging the p H of gastric mucosa and mixed venous blood oxygen saturation by lactic acid value in peripheral blood gas analysis.At present,with the development of science and technology,non-invasive monitoring technology can realize the bedside visual monitoring of microcirculation changes,including imaging technology（Sidestream dark field,SDF）imaging technology,（Orthogonal polarization spectral,OPS）imaging technology,（Incident dark field imaging,IDF）imaging technologyand laser speckled blood flow imaging Among them,the side-flow dark field imaging technology SDF is a bedside non-invasive monitoring method of sublingual microcirculation widely used in clinical practice.It can reflect the changes of human microcirculation by observing sublingual microcirculation.When the macrocirculation and microcirculation are separated,it can directly affect the physiological functions of various organs In this study,the side-flow dark field imaging technology SDF green light imaging technology was used to evaluate the changes of sublingual microcirculation before and after anesthesia induction with propofol and remazolam under direct vision At present,the effect of Remazolam benzoate on sublingual microcirculation during anesthesia induction in patients undergoing off-pump coronary artery bypass grafting has not been reported.The purpose of this study was to observe the effect of Remazolam benzoate on sublingual microcirculation during anesthesia induction in patients undergoing off-pump coronary artery bypass grafting compared with propofolObjective:To observe the effect of Remazolam compared with propofol on the circulatory system during anesthesia induction in patients undergoing off-pump coronary artery bypass grafting.Methods:A total of 42 patients undergoing non-stop coronary artery bypass grafting under general anesthesia were selected.Random number table method was used to divide the group into two groups:Remazolam group（R group,n=21）and propofol group（P group,n=21）.Anesthesia induction in R group:intravenous injection of Remazolam 6 mg·kg^-1·h^-1 was completed within 2.5 minutes,the patient lost consciousness and did not respond to shoulder tapping.The maintenance dose was adjusted to 0.15-0.3 mg·kg^-1·h^-1.Group P was injected 1.5-2.0 mg/kg propofol intravenously,and the injection was completed within 2.5 min.When patients lost consciousness and did not respond to shoulder tapping,the maintenance dose was adjusted to2.0-4.0 mg·kg^-1·h^-1.BIS 45-55 was maintained in the two groups.If BIS value>55,additional sedative drugs were added.BIS value was still>55 after 2 min,other sedative drugs were used,and this study was excluded.Anesthesia maintenance:intermittent intravenous administration of cisatracurium benzoate 5 mg and sufentanil 50μg.At the end of the suture,stop using all medications.The EU parameters of sublingual microcirculation were recorded before induction（T1）,immediately after intubation（T2）and 30 min after intubation（T3）.Mean arterial pressure and heart rate during anesthesia induction were recorded.The occurrence of adverse cardiovascular events and the use of active cardiovascular drugs during the induction period were recorded.Results:1.Compared with（T1）,All proportion of perfused vessels with EU parameters of sublingual microcirculation in group P（T2）（All proportion of perfused vessels,APPV（%））,Small proportion of perfused vessels（SPPV（%））,All perfused vessel density（All perfused vessel density,APVD（mm/mm²））and Small perfused vessel density（SPVD（mm/mm²））were decreased,but the difference was not statistically significant（P>0.05）.2.Compared with（T1）,the perfusion vascular ratio APPV（%）of all vessels,the perfusion vascular ratio SPPV（%）of small vessels and the perfusion vascular density APVD（mm/mm²）of all vessels in group P（T3）in the subglossal microcirculation EU parameter were significantly decreased（P<0.05）.The vascular density SPVD（mm/mm²）of perfusion in small vessels was decreased,but the difference was not statistically significant（P>0.05）.3.Compared with（T1）,the perfusion vascular ratio APPV（%）of all vessels,the perfusion vascular ratio SPPV（%）of small vessels,the perfusion vascular density APVD（mm/mm²）of all vessels and the perfusion vascular density SPVD（mm/mm²）of small vessels in the subglossal microcirculation EU parameters in the R group（T2）and（T3）decreased.But the difference was not statistically significant（P>0.05）.4.Compared with Group P（T3）,In R group（T3）,the proportion of perfusion vessels SPPV（%）of EU parameter small vessels of sublingual microcirculation was significantly increased（P<0.05）,there was no statistical significance in APPV（%）,APVD（mm/mm²）and SPVD（mm/mm²）of all blood vessels（P>0.05）.5.Compared with group P,the incidence of hypotension during anesthesia induction was significantly decreased in group R（P<0.05）,and the utilization rate and dosage of norepinephrine were significantly decreased in group R（P<0.05）.Conclusion:1.Compared with propofol,Remazolam has less inhibitory effect on sublingual microcirculation during anesthesia induction in patients undergoing off-pump coronary artery bypass grafting.2.Compared with the propofol group,the incidence of hypotension during anesthesia induction was lower in the Remazolam group,indicating that Remazolam is more stable in the anesthesia induction period for patients undergoing off-cardiopulmonary bypass grafting than in the propofol group.