The degree of respiratory depression according to the effect-site concentration in remimazolam target-controlled infusion: A randomised controlled trial.
Eur J Anaesthesiol
; 41(10): 728-737, 2024 Oct 01.
Article
en En
| MEDLINE
| ID: mdl-39076003
ABSTRACT
BACKGROUND:
Remimazolam is not only associated with a lower incidence of respiratory depression than propofol but also in itself has the risk of respiratory depression.OBJECTIVE:
We investigated respiratory depression following remimazolam infusion, targeting different effect-site concentrations using target-controlled infusion.DESIGN:
A prospective, double-blind, randomised controlled study.SETTING:
Tertiary hospital, Suwon, South Korea, from April 2022 to November 2022.PARTICIPANTS:
One hundred and seven patients scheduled for general anaesthesia were randomised into three groups targeting remimazolam effect-site concentrations of 500 (RMZ-500) ( n â=â36), 1000 (RMZ-1000) ( n â=â35) and 1500ângâml -1 (RMZ-1500) ( n â=â36).INTERVENTIONS:
Remimazolam was solely infused for 10âmin according to target effect-site concentrations. According to the degree of SpO 2 decrease, oxygen desaturations were managed with the following respiratory supports jaw-thrust for SpO 2 less than 97%, 100% oxygen delivery for SpO 2 less than 93% and assisted ventilation for SpO 2 less than 90%. MAIN OUTCOMEMEASURES:
The incidence of each respiratory support, along with respiratory variables (at baseline, 5âmin and 10âmin after remimazolam infusion) and loss of consciousness were observed for 10âmin after remimazolam target-controlled infusion.RESULTS:
Both RMZ-1000 and RMZ-1500 required more frequent respiratory support than RMZ-500 (both P â<â0.001), with nearly identical frequencies between RMZ-1000 and RMZ-1500. In terms of respiratory support, the incidence of assisted ventilation was significantly lower in RMZ-500 (2.8%) than RMZ-1000 (48.6%) and RMZ-1500 (50%) ( P â<â0.001). RMZ-1000 and RMZ-1500 achieved loss of consciousness in all patients; RMZ-500 only achieved loss of consciousness in 86.1% of patients ( P â=â0.010). In patients who maintained spontaneous respiration, tidal volume decreased by 41 to 48% and respiratory rate increased by 118 to 158% at 5 and 10âmin, significantly compared to baseline in all groups ( P â<â0.001).CONCLUSIONS:
Remimazolam infusion, like that of other benzodiazepines, led to respiratory depression, which was more prominent at higher target effect-site concentrations. Therefore, appropriate countermeasures should be developed to prevent oxygen desaturation. TRIAL REGISTRATION CRIS ( https//cris.nih.go.kr ), identifier KCT0006952.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Insuficiencia Respiratoria
/
Hipnóticos y Sedantes
Límite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
País/Región como asunto:
Asia
Idioma:
En
Revista:
Eur J Anaesthesiol
Asunto de la revista:
ANESTESIOLOGIA
Año:
2024
Tipo del documento:
Article