Prospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2021; 9(34): 10595-10603
Published online Dec 6, 2021. doi: 10.12998/wjcc.v9.i34.10595
Remimazolam benzenesulfonate anesthesia effectiveness in cardiac surgery patients under general anesthesia
Fang Tang, Jian-Min Yi, Hong-Yan Gong, Zi-Yun Lu, Jie Chen, Bei Fang, Chen Chen, Zhi-Yi Liu
Fang Tang, Jian-Min Yi, Hong-Yan Gong, Zi-Yun Lu, Jie Chen, Bei Fang, Chen Chen, Zhi-Yi Liu, Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Tang F and Yi JM designed the experiment; Gong HY drafted the work; Lu ZY, Chen J and Fang B collected the data; Chen C and Liu ZY analyzed and interpreted data; Tang F, Yi JM and Liu ZY wrote the article.
Institutional review board statement: This study was approved by The First Affiliated Hospital of Nanchang University Ethics Committee.
Clinical trial registration statement: This study is registered at clinical hospital center trial registry. The registration identification number is 2020BL-015-10.
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors declared that there is no conflict of interest.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The manuscript was checked and revised according to the CONSORT 2010.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Yi Liu, MD, Associate Chief Physician, Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, No. 17 Yongwai Road, Donghu District, Nanchang 330006, Jiangxi Province, China. xiaoniuniu202107@163.com
Received: July 28, 2021
Peer-review started: July 28, 2021
First decision: August 19, 2021
Revised: August 28, 2021
Accepted: October 14, 2021
Article in press: October 14, 2021
Published online: December 6, 2021
Abstract
BACKGROUND

Sedation with propofol injections is associated with a risk of addiction, but remimazolam benzenesulfonate is a comparable anesthetic with a short elimination half-life and independence from cell P450 enzyme metabolism. Compared to remimazolam, remimazolam benzenesulfonate has a faster effect, is more quickly metabolized, produces inactive metabolites and has weak drug interactions. Thus, remimazolam benzenesulfonate has good effectiveness and safety for diagnostic and operational sedation.

AIM

To investigate the clinical value of remimazolam benzenesulfonate in cardiac surgery patients under general anesthesia.

METHODS

A total of 80 patients who underwent surgery in the Department of Cardiothoracic Surgery from August 2020 to April 2021 were included in the study. Using a random number table, patients were divided into two anesthesia induction groups of 40 patients each: remimazolam (0.3 mg/kg remimazolam benzenesulfonate) and propofol (1.5 mg/kg propofol). Hemodynamic parameters, inflammatory stress response indices, respiratory function indices, perioperative indices and adverse reactions in the two groups were monitored over time for comparison.

RESULTS

At pre-anesthesia induction, the remimazolam and propofol groups did not differ regarding heart rate, mean arterial pressure, cardiac index or volume per wave index. After endotracheal intubation and when the sternum was cut off, mean arterial pressure and volume per wave index were significantly higher in the remimazolam group than in the propofol group (P < 0.05). After endotracheal intubation, the oxygenation index and the respiratory index did not differ between the groups. After endotracheal intubation and when the sternum was cut off, the oxygenation index values were significantly higher in the remimazolam group than in the propofol group (P < 0.05). Serum interleukin-6 and tumor necrosis factor-α levels 12 h after surgery were significantly higher than before surgery in both groups (P < 0.05). The observation indices were re-examined 2 h after surgery, and the epinephrine, cortisol and blood glucose levels were significantly higher in the remimazolam group than in the propofol group (P < 0.05). The recovery and extubation times were significantly lower in the remimazolam group than in the propofol group (P < 0.05); there were significantly fewer adverse reactions in the remimazolam group (10.00%) than in the propofol group (30.00%; P < 0.05).

CONCLUSION

Compared with propofol, remimazolam benzenesulfonate benefited cardiac surgery patients under general anesthesia by reducing hemodynamic fluctuations. Remimazolam benzenesulfonate influenced the surgical stress response and respiratory function, thereby reducing anesthesia-related adverse reactions.

Keywords: Anesthesia, Thoracic surgery, Cardiac surgery, Cardiopulmonary bypass, Hemodynamics, Propofol, Drug-related side effects, Adverse reactions

Core Tip: Remimazolam benzenesulfonate anesthesia has good effectiveness and safety for diagnostic and operational sedation but has not been evaluated for cardiac surgery. This study investigated the clinical value of remimazolam benzenesulfonate in cardiac surgery patients under general anesthesia. Compared with propofol, remimazolam benzenesulfonate benefitted cardiac surgery patients under general anesthesia by reducing hemodynamic fluctuations and influencing the surgical stress response and respiratory function, thereby reducing anesthesia-related adverse reactions.