【原】【罂粟摘要】瑞玛唑仑用于声门上通气技术的一项随机对照研究

瑞玛唑仑用于声门上通气技术的一项随机对照研究

贵州医科大学  麻醉与心脏电生理课题组

翻译：王子君  编辑：王婷婷  审校：曹莹  

目的：抬下颌向时患者无运动反射是简单的声门上通气技术的一个有用指标。本研究的目的是通过下颌反射消失来评估瑞玛唑仑对建立声门上气道的适用性。

方法：70例在全身麻醉下进行择期手术的患者被随机分为两组。一组(瑞玛唑仑组)输注瑞玛唑仑12 mg kg−1 h−1(最大50 mg)，另一组(丙泊酚组)输注丙泊酚120 mg kg−1 h−1(最大500 mg)。但患者睫毛反射消失，对下颌反射进行评估。主要结局指标是在达到试验药物的最大剂量之前对下颌反射的消失的患者比例。我们拟采用Pocock调整法对40例患者进行(一次)中期分析。

结果：从中期分析结果来看，该研究在招募了40例患者后停止。丙泊酚组21例患者(100%)对抬下颌无反应，瑞玛唑仑组19例患者中有9例(47%)对抬下颌无反应。两组间比例有显著差异(P = 0.0001, 95% CI：30-75%)。

结论：瑞玛唑仑对下颌反射的抑制作用较差，因此瑞玛唑仑并不适用于简单的声门上通气技术，除非合并使用神经肌肉阻滞剂或阿片类药物。

原始文献来源：Hayato Arime , Takashi Asai , Tomoyuki Saito , Yasuhisa Okuda. Remimazolam: a randomized controlled study of its suitability for insertion of a supraglottic airway.J Anesth. 2023 Oct;37(5):762-768. doi: 10.1007/s00540-023-03231-2. Epub 2023 Jul 25.

Remimazolam: a randomized controlled study of its suitability for insertion of a supraglottic airway

Purpose: Loss of motor response to thrusting the jaw forward is a useful indicator for uncomplicated insertion of a supraglottic airway. The aim of this study was to assess the suitability of remimazolam for insertion of a supraglottic airway assessed by loss of response to jaw thrusting.

Methods: Seventy patients, who were scheduled for elective surgeries under general anesthesia, were allocated randomly to one of two groups. In one group (remimazolam group), remimazolam was infused 12 mg kg-1 h-1 (50 mg maximum), and in the other (propofol group), propofol was infused at 120 mg kg-1 h-1 (500 mg maximum). Once the eyelash reflex disappeared, response to jaw thrusting was assessed. Primary outcome measure was the proportion of patients with loss of response to jaw thrusting before reaching the maximum dose of the test drug. We planned an interim analysis (of one time) after 40 patients, using the Pocock adjustment method.

Results: From the interim analysis results, the study was stopped after recruitment of 40 patients. Loss of response to jaw thrusting was observed in all of 21 patients (100%) in the propofol group, and in 9 of 19 patients (47%) in the remimazolam group. There was a significant difference in the proportion between the groups (P = 0.0001, 95% CI for difference 30-75%).

Conclusion: Remimazolam frequently does not inhibit response to jaw thrusting, and thus remimazolam is not a suitable induction agent for uncomplicated insertion of a supraglottic airway unless either a neuromuscular blocking agent or an opioid is co-administered.