Effects of remimazolam on intraoperative cerebral oxygen saturation and postoperative cognitive function in elderly patients with nasal endoscopic surgery
AIM To investigate the effects of remimazolam on intraoperative cerebral oxygen saturation and postoperative cognitive function in elderly patients undergoing nasal endoscopy.METHODS Sixty elderly patients proposed for nasal endoscopic surgery were selected and randomly divided equally into two groups.The control group was given propofol 2.0 mg·kg-1 for induction and propofol 4-6 mg·kg-1·h-1 for maintenance,while the trial group was given remimazolam 0.3 mg·kg-1 for induction and remimazolam 0.2-0.3 mg·kg-1·h-1 for maintenance,and other anesthetic induction and maintenance doses were the same for the two groups.Nitroglycerin 0.5-2.0 g·kg-1·min-1 was pumped intravenously to maintain the mean arterial pressure(MAP)at 50-65 mmHg,and the pumping was stopped at the end of the procedure.Regional cerebral oxygen saturation(rcSO2)was monitored intraoperatively,and serum S100 and interleukin(IL)-6 concentrations were measured before induction of anesthesia,after extubation,and 1 h after surgery.The cognitive function was assessed by Montreal Cognitive Assessment(MoCA),the hemodynamic indicators were measured,and the quality of postoperative awakening was observed.RESULTS There was no significant difference in MoCA scores between the two groups 1 d preoperatively,1 d and 7 d postoperatively(P＞0.05).And there was no significant difference in the incidence of postoperative cognitive dysfunction(POCD)between the two groups 1d and 7d postoperatively(P＞0.05).Compared with the control group,rcSO2 was significantly higher after blood pressure reduction in the trial group(P＜0.05),and the maximum decrease in rcSO2 was significantly reduced(P＜0.05).Compared with the control group,the S100βconcentration immediately after extubation and 1 h after surgery was significantly lower in the trial group(P＜0.05),and the IL-6 concentration immediately after extubation was also significantly lower(P＜0.05).Compared with the control group,heart rate and MAP were significantly higher in the trial group immediately after intubation(P＜0.05),and bispectral index values were significantly higher in the trial group immediately after hypotension and immediately after the end of surgery(P＜0.05).The induction time of the trial group was significantly longer than that of the control group(P＜0.05),while the time of eye opening and extubation was significantly shorter than that of the control group(P＜0.05).There was no significant difference in pain and sedation scores at 1 h and 3 h postoperatively between the two groups(P＞0.05),and no obvious adverse reactions occurred in any of them.CONCLUSION Remimazolam can reduce the production of S100βand IL-6,and improves cerebral oxygen saturation to some extent in elderly patients undergoing nasal endoscopy,but has no significant effect on the occurrence of POCD.
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