全部 标题 作者
关键词 摘要

OALib Journal期刊
ISSN: 2333-9721
费用:99美元

查看量下载量

相关文章

更多...

瑞马唑仑在老年患者全麻中应用的研究进展
Research Progress of Remazolam for General Anesthesia in Elderly Patients

DOI: 10.12677/ACM.2023.13112553, PP. 18195-18203

Keywords: 老年患者,瑞马唑仑,麻醉,丙泊酚
Elderly Patient
, Remimazolam, Anesthesia, Propofol

Full-Text   Cite this paper   Add to My Lib

Abstract:

当今社会老龄化进程加速,老年人口数量剧增。由于老年患者重要器官、系统的功能衰竭,此类患者的麻醉风险远大于其他年龄层的患者。合理地选择老年患者的麻醉用药是提高医疗安全的必要措施。瑞马唑仑是一种新型短效的苯二氮卓类镇静药,清除度高、稳态分布体积小、消除半衰期短、起效快、组织蓄积小、镇静作用可被拮抗。临床研究证明瑞马唑仑已成功用于全麻诱导和维持时,血流动力学更稳定;呼吸、循环抑制作用更轻;麻醉复苏快且复苏质量高;并发症相对更少。本文结合老年患者的病理及生理改变和瑞马唑仑的药理学特点,论述瑞马唑仑用于老年患者麻醉全身麻醉的现状和未来的发展趋势。
The aging process of today’s society is accelerating, and the number of old people is soaring. Due to the failure of vital organs and systems in elderly patients, the risk of anesthesia in such patients is much greater than that in patients of other ages. Reasonable selection of anesthetic drugs for aged patients is a necessary measure to improve medical safety. Remazolam is a new short-acting benzo-diazepine sedative with high clearance, small steady-state distribution volume, short elimination half-life, quick onset, small tissue accumulation and antagonistic sedation. Clinical studies have proved that Remazolam has been successfully used for induction and maintenance of general anes-thesia, and hemodynamics is more stable. Respiratory and circulatory inhibition effect is lighter; Anesthetic resuscitation is fast and high quality; there are relatively few complications. Based on the pathological and physiological changes of elderly patients and the pharmacological characteris-tics of remazolam, the present situation and future development trend of remazolam for general anesthesia in elderly patients were discussed.

References

[1]  Bao, J., Zhou, L., Liu, G., et al. (2022) Current State of Care for the Elderly in China in the Context of an Aging Popula-tion. Bioscience Trends, 16, 107-118.
https://doi.org/10.5582/bst.2022.01068
[2]  Tu, W., Zeng, X. and Liu, Q. (2022) Aging Tsunami Coming: The Main Finding from China’s Seventh National Population Census. Aging Clinical and Experimental Research, 34, 1159-1163.
https://doi.org/10.1007/s40520-021-02017-4
[3]  Olotu, C. (2021) Anesthesia for the Elderly: A Narrative Review. Minerva Anestesiologica, 87, 1128-1138.
https://doi.org/10.23736/S0375-9393.21.15388-X
[4]  Short, T.G., Campbell, D., Frampton, C., et al. (2019) An-aesthetic Depth and Complications after Major Surgery: An International, Randomised Controlled Trial. The Lancet, 394, 1907-1914.
https://doi.org/10.1016/S0140-6736(19)32315-3
[5]  Luca, E., Schipa, C., Cambise, C., Sollazzi, L. and Aceto, P. (2023) Implication of Age-Related Changes on Anesthesia Management. Saudi Journal of Anesthesia, 17, 474-481.
https://doi.org/10.1016/S0140-6736(19)32315-3
[6]  Wang, C., Gao, Y., Li, J., et al. (2023) Safety and Effective-ness of the Combination of Remimazolam Tosilate and Propofol in Gastroscopy: A Multicenter, Randomized Controlled, Single-Blind Clinical Trial. Frontiers in Pharmacology, 14, Article 1124667.
https://doi.org/10.3389/fphar.2023.1124667
[7]  Schonberger, R., Dai, F., Michel, G., et al. (2022) Association of Propofol Induction Dose and Severe Pre-Incision Hypotension among Surgical Patients over Age 65. Journal of Clinical Anesthesia, 80, Article ID: 110846.
https://doi.org/10.1016/j.jclinane.2022.110846
[8]  Chai, G., Wu, J., Fang, R., et al. (2022) Sevoflurane Inhibits Histone Acetylation and Contributes to Cognitive Dysfunction by Enhancing the Expression of ANP32A in Aging Mice. Behavioural Brain Research, 431, Article ID: 113949.
https://doi.org/10.1016/j.bbr.2022.113949
[9]  Lv, G., Li, C., Wang, W., Li, N. and Wang, K. (2020) Silencing SP1 Alleviated Sevoflurane-Induced POCD Development via Cholinergic Anti-inflammatory Pathway. Neurochemical Research, 45, 2082-2090.
https://doi.org/10.1007/s11064-020-03070-7
[10]  Qin, J., Ma, Q. and Ma, D. (2020) Low-Dose Sevoflurane At-tenuates Cardiopulmonary Bypass (CPB)-Induced Postoperative Cognitive Dysfunction (POCD) by Regulating Hippo-campus Apoptosis via PI3K/AKT Pathway. Current Neurovascular Research, 17, 232-240.
https://doi.org/10.2174/1567202617666200513085403
[11]  Ge, X., Zuo, Y., Xie, J., et al. (2021) A New Mecha-nism of POCD Caused by Sevoflurane in Mice: Cognitive Impairment Induced by Cross-Dysfunction of Iron and Glu-cose Metabolism. Aging, 13, 22375-22389.
https://doi.org/10.18632/aging.203544
[12]  Zucco, L., Santer, P., Levy, N., et al. (2021) A Comparison of Postop-erative Respiratory Complications Associated with the Use of Desflurane and Sevoflurane: A Single-Centre Cohort Study. Anaesthesia, 76, 36-44.
https://doi.org/10.1111/anae.15203
[13]  Franzén, S., Semenas, E., Taavo, M., et al. (2022) Renal Function during Sevoflurane or Total Intravenous Propofol Anaesthesia: A Single-Centre Parallel Randomised Controlled Study. British Journal of Anaesthesia, 128, 838-848.
https://doi.org/10.1016/j.bja.2022.02.030
[14]  Doi, M., Morita, K., Takeda, J., et al. (2020) Efficacy and Safety of Remimazolam versus Propofol for General Anesthesia: A Multicenter, Single-Blind, Randomized, Parallel-Group, Phase IIb/III Trial. Journal of Anesthesia, 34, 543-553.
https://doi.org/10.1007/s00540-020-02788-6
[15]  Paton, D. (2021) Remimazolam: A Short-Acting Benzodiazepine for Procedural Sedation. Drugs of Today, 57, 337-346.
https://doi.org/10.1358/dot.2021.57.5.3264119
[16]  Kilpatrick, G., McIntyre, M., Cox, R., et al. (2007) CNS 7056: A Novel Ultra-Short-Acting Benzodiazepine. Anesthesiology, 107, 60-66.
https://doi.org/10.1097/01.anes.0000267503.85085.c0
[17]  Zhou, Y., Hu, P. and Jiang, J. (2017) Metabolite Char-acterization of a Novel Sedative Drug, Remimazolam in Human Plasma and Urine Using Ultra High-Performance Liquid Chromatography Coupled with Synapt High-Definition Mass Spectrometry. Journal of Pharmaceutical and Biomedical Analysis, 137, 78-83.
https://doi.org/10.1016/j.jpba.2017.01.016
[18]  Kim, K. (2022) Remimazolam: Pharmacological Characteristics and Clinical Applications in Anesthesiology. Anesthesia and Pain Medicine, 17, 1-11.
https://doi.org/10.17085/apm.21115
[19]  Masui, K. (2020) Remimazolam Besilate, a Benzodiazepine, Has Been Approved for General Anesthesia!! Journal of Anesthesia, 34, 479-482.
https://doi.org/10.1007/s00540-020-02755-1
[20]  Wesolowski, A., Zaccagnino, M., Malapero, R., et al. (2016) Remimazolam: Pharmacologic Considerations and Clinical Role in Anesthesiology. Pharmacotherapy, 36, 1021-1027.
https://doi.org/10.1002/phar.1806
[21]  St?hr, T., Colin, P., Ossig, J., et al. (2021) Pharmacokinetic Properties of Remimazolam in Subjects with Hepatic or Renal Impairment. British Journal of Anaesthesia, 127, 415-423.
https://doi.org/10.1016/j.bja.2021.05.027
[22]  Chae, D., Kim, H., Song, Y., Choi, Y.S. and Han, D.W. (2022) Pharmacodynamic Analysis of Intravenous Bolus Remimazolam for Loss of Consciousness in Patients Undergoing General Anaesthesia: A Randomised, Prospective, Double-Blind Study. British Journal of Anaesthesia, 129, 49-57.
https://doi.org/10.1016/j.bja.2022.02.040
[23]  Doi, M., Hirata, N., Suzuki, T., et al. (2020) Safety and Efficacy of Remimazolam in Induction and Maintenance of General Anesthesia in High-Risk Surgical Patients (ASA Class III): Re-sults of a Multicenter, Randomized, Double-Blind, Parallel-Group Comparative Trial. Journal of Anesthesia, 34, 491-501.
https://doi.org/10.1007/s00540-020-02776-w
[24]  Dai, G., Pei, L., Duan, F., et al. (2021) Safety and Efficacy of Remimazolam Compared with Propofol in Induction of General Anesthesia. Minerva Anestesiologica, 87, 1073-1079.
https://doi.org/10.23736/S0375-9393.21.15517-8
[25]  Nakanishi, T., Sento, Y., Kamimura, Y., et al. (2021) Remimazolam for Induction of Anesthesia in Elderly Patients with Severe Aortic Stenosis: A Prospective, Observational Pilot Study. BMC Anesthesiology, 21, Article No. 306.
https://doi.org/10.1186/s12871-021-01530-3
[26]  Saito, K., Ohno, S., Maeda, M., et al. (2021) Remimazolam An-esthesia for Cardiac Surgery with Cardiopulmonary Bypass: A Case Report. JA Clinical Reports, 7, Article No. 21.
https://doi.org/10.1186/s40981-021-00424-0
[27]  Satoh, T., Nishihara, N., Sawashita, Y., et al. (2021) Remimazo-lam Anesthesia for MitraClip Implantation in a Patient with Advanced Heart Failure. Case Reports in Anesthesiology, 2021, Article ID: 5536442.
https://doi.org/10.1155/2021/5536442
[28]  Hasegawa, G., Hirata, N., Yoshikawa, Y. and Yamakage, M. (2022) Differential Effects of Remimazolam and Propofol on Heart Rate Variability during Anesthesia Induction. Journal of An-esthesia, 36, 239-245.
https://doi.org/10.1007/s00540-022-03037-8
[29]  Lee, J., Kim, H., Kim, Y., et al. (2022) Anesthetic Management Using Remimazolam in a Patient with Atrial Flutter: A Case Report. American Journal of Translational Research, 14, 5754-5759.
[30]  Nakayama, J., Ogihara, T., Yajima, R., Innami, Y. and Ouchi, T. (2021) Anesthetic Management of Super-Elderly Patients with Remimazolam: A Report of Two Cases. JA Clinical Reports, 7, Article No. 71.
https://doi.org/10.1186/s40981-021-00474-4
[31]  Lee, B., Kim, M., Kong, H., et al. (2022) Effects of Remimazo-lam vs. Sevoflurane Anesthesia on Intraoperative Hemodynamics in Patients with Gastric Cancer Undergoing Robotic Gastrectomy: A Propensity Score-Matched Analysis. Journal of Clinical Medicine, 11, Article 2643.
https://doi.org/10.3390/jcm11092643
[32]  Hari, Y., Satomi, S., Murakami, C., et al. (2022) Remimazolam De-creased the Incidence of Early Postoperative Nausea and Vomiting Compared to Desflurane after Laparoscopic Gyneco-logical Surgery. Journal of Anesthesia, 36, 265-269.
https://doi.org/10.1007/s00540-022-03041-y
[33]  Jo, H., Lee, J., Jang, D., et al. (2018) Safety and Effectiveness of Midazolam for Cirrhotic Patients Undergoing Endoscopic Variceal Ligation. Turkish Journal of Gastroenterology, 29, 448-455.
[34]  Shi, F., Chen, Y., Li, H., Zhang, Y. and Zhao, T. (2022) Efficacy and Safety of Remimazolam Tosilate versus Propofol for General Anesthesia in Cirrhotic Patients Undergoing Endoscopic Variceal Ligation. International Journal of General Medicine, 15, 583-591.
https://doi.org/10.2147/IJGM.S345390
[35]  Onoda, A. and Suzuki, Y. (2022) A New Anesthetic, Remimazolam, Is Useful in the Management of Anesthesia in Patients with Liver Cirrhosis. Case Reports in Anesthesiology, 2022, Article ID: 9268454.
https://doi.org/10.1155/2022/9268454
[36]  Freyer, N., Kn?spel, F., Damm, G., et al. (2019) Metabolism of Remi-mazolam in Primary Human Hepatocytes during Continuous Long-Term Infusion in a 3-D Bioreactor System. Drug De-sign, Development and Therapy, 13, 1033-1047.
https://doi.org/10.2147/DDDT.S186759
[37]  Fang, H., Zhang, Y., Wang, J., et al. (2021) Remimazolam Reduces Sepsis-Associated Acute Liver Injury by Activation of Peripheral Benzodiazepine Receptors and p38 Inhibition of Mac-rophages. International Immunopharmacology, 101, Article ID: 108331.
https://doi.org/10.1016/j.intimp.2021.108331
[38]  Choi, J., Lee, H., Kim, J., et al. (2022) Comparison of Remima-zolam-Based and Propofol-Based Total Intravenous Anesthesia on Postoperative Quality of Recovery: A Randomized Non-Inferiority Trial. Journal of Clinical Anesthesia, 82, Article ID: 110955.
https://doi.org/10.1016/j.jclinane.2022.110955
[39]  Zhang, J., Wang, X., Zhang, Q., Wang, Z.C. and Zhu, S.F. (2022) Application Effects of Remimazolam and Propofol on Elderly Patients Undergoing Hip Replacement. BMC Anes-thesiology, 22, Article No. 118.
https://doi.org/10.1186/s12871-022-01641-5
[40]  Tang, F., Yi, J., Gong, H., et al. (2021) Remimazolam Benzene-sulfonate Anesthesia Effectiveness in Cardiac Surgery Patients under General Anesthesia. World Journal of Gastroen-terology, 9, 10595-10603.
https://doi.org/10.12998/wjcc.v9.i34.10595
[41]  Liu, X., Guo, L., Duan, B., et al. (2022) Novel Benzodiazepine Remimazolam Tosylate Delays Neurodegeneration of Aged Mice via Decreasing Tau Phosphorylation. Neurotoxicology, 92, 156-165.
https://doi.org/10.1016/j.neuro.2022.08.003
[42]  Song, S., Jang, Y., Yoon, M., et al. (2022) Quality of Recovery in Patients Administered Remimazolam versus Those Administered an Inhalant Agent for the Maintenance of General Anesthesia: A Randomized Control Trial. BMC Anesthesiology, 22, Article No. 226.
https://doi.org/10.1186/s12871-022-01770-x
[43]  Xu, H., Xu, G., Ren, C., et al. (2019) Effect of Forced-Air Warming System in Prevention of Postoperative Hypothermia in Elderly Patients: A Prospective Controlled Trial. Medi-cine, 98, e15895.
https://doi.org/10.1097/MD.0000000000015895
[44]  Lee, C., Lee, C., Lee, J., et al. (2022) Comparison of Core Body Temperatures in Patients Administered Remimazolam or Propofol during Robotic-Assisted and Laparoscopic Rad-ical Prostatectomy. Medicina, 58, Article 690.
https://doi.org/10.3390/medicina58050690
[45]  Rex, D., Bhandari, R., Desta, T., et al. (2018) A Phase III Study Evaluating the Efficacy and Safety of Remimazolam (CNS 7056) Compared with Placebo and Midazolam in Patients Undergoing Colonoscopy. Gastrointestinal Endoscopy, 88, 427-437.E6.
https://doi.org/10.1016/j.gie.2018.04.2351
[46]  Hu, B., Jiang, K., Shi, W., et al. (2022) Effect of Remimazolam Tosilate on Respiratory Depression in Elderly Patients Undergoing Gastroscopy: A Multicentered, Prospective, and Randomized Study. Drug Design, Development and Therapy, 16, 4151-4159.
https://doi.org/10.2147/DDDT.S391147
[47]  Pastis, N., Yarmus, L., Schippers, F., et al. (2019) Safety and Effi-cacy of Remimazolam Compared with Placebo and Midazolam for Moderate Sedation during Bronchoscopy. Chest, 155, 137-146.
https://doi.org/10.1016/j.chest.2018.09.015
[48]  Chen, X., Xin, D., Xu, G., et al. (2022) The Efficacy and Safety of Remimazolam Tosilate versus Dexmedetomidine in Outpatients Undergoing Flexible Bronchoscopy: A Prospective, Randomized, Blind, Non-Inferiority Trial. Frontiers in Pharmacology, 13, Article 902065.
https://doi.org/10.3389/fphar.2022.902065
[49]  Darie, A., Schumann, D., Laures, M., et al. (2020) Oxygen Desat-uration during Flexible Bronchoscopy with Propofol Sedation Is Associated with Sleep Apnea: The PROSA-Study. Res-piratory Research, 21, Article No. 306.
https://doi.org/10.1186/s12931-020-01573-z
[50]  Tsurumi, K., Takahashi, S., Hiramoto, Y., et al. (2021) Remi-mazolam Anaphylaxis during Anesthesia Induction. Journal of Anesthesia, 35, 571-575.
https://doi.org/10.1007/s00540-021-02934-8
[51]  Yoshida, K., Tanaka, S. and Watanabe, K. (2021) A Case of In-travenous Line Occlusion When Using Acetated Ringer’s Solution and Remimazolam. Journal of Clinical Anesthesia, 70, Article ID: 110190.
https://doi.org/10.1016/j.jclinane.2021.110190
[52]  Yamaoka, M., Kuroda, K., Matsumoto, N., et al. (2022) Rem-imazolam Anaphylaxis Confirmed by Serum Tryptase Elevation and Skin Test. Anaesthesia Reports, 10, e12167.
https://doi.org/10.1002/anr3.12167
[53]  Hasushita, Y., Nagao, M., Miyazawa, Y., Yunoki, K. and Mima, H. (2022) Cardiac Arrest following Remimazolam-Induced Anaphylaxis: A Case Report. A & A Practice, 16, e01616.
https://doi.org/10.1213/XAA.0000000000001616
[54]  Uchida, S., Takekawa, D., Kitayama, M. and Hirota, K. (2022) Two Cases of Circulatory Collapse Due to Suspected Remimazolam Anaphylaxis. JA Clinical Reports, 8, Article No. 18.
https://doi.org/10.1186/s40981-022-00508-5
[55]  Yokose, M., Takaki, R., Mihara, T., et al. (2022) Hypo-tension after General Anesthesia Induction Using Remimazolam in Geriatric Patients: Protocol for a Double-Blind Ran-domized Controlled Trial. PLOS ONE, 17, e0275451.
https://doi.org/10.1371/journal.pone.0275451
[56]  Liu, M., Sun, Y., Zhou, L., et al. (2022) The Median Effective Dose and Bispectral Index of Remimazolam Tosilate for Anesthesia Induction in Elderly Patients: An Up-and-Down Se-quential Allocation Trial. Clinical Interventions in Aging, 17, 837-843.
https://doi.org/10.2147/CIA.S364222
[57]  Zhao, T., Chen, D., Sun, H., et al. (2022) Moderate Sedation with Sin-gle-Dose Remimazolam Tosilate in Elderly Male Patients Undergoing Transurethral Resection of the Prostate with Spinal Anesthesia: A Prospective, Single-Arm, Single-Centre Clinical Trial. BMC Anesthesiology, 22, Article No. 247.
https://doi.org/10.1186/s12871-022-01788-1
[58]  Tang, Y., Yang, X., Yu, Y., et al. (2022) Remimazolam Besylate versus Propofol for Long-Term Sedation during Invasive Mechanical Ventilation: A Pilot Study. Critical Care, 26, Arti-cle No. 279.
https://doi.org/10.1186/s13054-022-04168-w

Full-Text

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133