Objective To evaluate the effective dose,efficacy and safety of remimazolam for in-duction of general anesthesia in super-elderly patients.Methods Trial Ⅰ American Society of Anesthesi-ologists Physical Status classification Ⅰ-Ⅲ patients of either sex,aged ≥80 yr,with body mass index of 18-25 kg/m2,undergoing elective surgery with general anesthesia in the Zhejiang Provincial People's Hos-pital from January to March 2022,were selected.Remimazolam 0.12 mg/kg or propofol 0.8 mg/kg was intra-venously injected in the first patient,and the dose of remimazolam or propofol in the next patient was deter-mined by using the modified Dixon's up-and-down method.The difference between the two successive doses was 0.01 mg/kg for remimazolam and 0.05 mg/kg for propofol.A positive response was defined as achieving an anesthesia depth(BIS value≤65)within 5 min of administration.If the response was positive,the next patient received a lower dose,or conversely if negative,a higher dose was given in the next patient.The 50％ effective dose(ED50)and 90％ effective dose(ED90)of remifentanil and propofol and their 95％ con-fidence intervals(CIs)were calculated by Probit method.Trial Ⅱ One hundred and forty-six American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ elderly patients of either sex,aged ≥80 yr,with a body mass index of 18-25 mg/kg,scheduled for elective surgery with general anesthesia from April to October 2023 in Zhejiang Provincial People's Hospital,were selected and divided into 2 groups(n=73 each)by using a random number table method:remimazolam group(R group)and propofol group(P group).R group was induced with intravenous remimazolam ED90 and P group was induced with intravenous propofol ED90,and the injection time was both 30 s.If the BIS value was still greater than 65 at 5 min after administration,remimazolam 0.05 mg/kg was intravenously added each time in R group and propofol 0.5 mg/kg was intravenously added each time in P group until the patient's BIS value ≤ 65.The success of anes-thesia induction,time for successful induction of anesthesia and rescue sedation were recorded.The occur-rence of intraoperative injection pain,hypertension,hypotension,bradycardia,hypoxemia,intraoperative awareness and postoperative delirium,nausea and vomiting was also recorded.Results Trial Ⅰ The ED50(95％ CI)of remimazolam was 0.148(0.139-0.157)mg/kg,and the ED90(95％ CI)was 0.160(0.153-0.202)mg/kg;the ED50(95％ CI)of propofol was 0.824(0.726-0.983)mg/kg,and the ED90(95％ CI)was 0.916(0.860-2.472)mg/kg.Trial Ⅱ Compared with group P,the time for successful induction of anes-thesia was significantly prolonged,the incidence of intraoperative injection pain and hypotension was de-creased(P＜0.05),and no significant change was found in the success rate of anesthesia induction,rate of rescue sedation,intraoperative hypertension,bradycardia,hypoxemia,postoperative delirium,and nausea and vomiting in group R(P＞0.05).Conclusions The ED50 and ED90 of remimazolam for induction of general anesthesia are 0.148 and 0.160 mg/kg,respectively,in super-elderly patients.Compared to propofol,remima-zolam has a slightly longer onset time,but it is safer when used for induction of general anesthesia in super-elderly patients.
关键词
苯二氮类/老年人,80以上/麻醉诱导/剂量效应关系,药物
Key words
Benzodiazepines/Aged,80 and over/Anesthesia induction/Dose-response rela-tionship,drug
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