Comparison of the hemodynamic effects of remimazolam tosylate and etomidate for anesthetic induction in elderly frail patients
10.11855/j.issn.0577-7402.0692.2025.0106
- VernacularTitle:甲苯磺酸瑞马唑仑与依托咪酯麻醉诱导对老年衰弱患者血流动力学影响的比较
- Author:
Xiao-Yu TAO
1
;
Shuang-Shuang GUAN
;
Chen-Xu DAI
;
Qiu-Feng WANG
;
Hui-Hui LI
;
Xing-Jun MA
;
Ning CAI
Author Information
1. 阜阳市人民医院麻醉科,安徽阜阳 236000
- Keywords:
frailty;
elderly;
remimazolam tosylate;
etomidate;
hemodynamics
- From:
Medical Journal of Chinese People's Liberation Army
2025;50(8):958-963
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the hemodynamic effects of anesthesia induction with remimazolam tosylate and etomidate in elderly frail patients.Methods This study was a single-center,prospective,randomized,single-blind trial.From January to April 2024,96 elderly frail patients undergoing elective surgery in Fuyang People's Hospital were recruited.After excluding 6 cases(3 refused to participate,1 had tracheal intubation time＞30 s,and 2 had missing data),90 patients were finally included.They were randomly divided into remimazolam tosylate group(intravenous injection of 0.2 mg/kg remimazolam tosylate for anesthesia induction,n=45)and etomidate group(intravenous injection of 0.3 mg/kg etomidate for anesthesia induction,n=45)by the random number table method.The area under the curve for mean arterial pressure(MAP)below or above baseline values(AUCMAP-and AUCMAP+),the heart rate(HR)below or above baseline values by 10％(AUCHR-and AUCHR+)within 10 minutes of anesthesia induction,the time to loss of consciousness,the time from the start of anesthesia induction to a bispectral index(BIS)＜60,the incidence of drug-related adverse reactions,the incidence of cardiovascular adverse events,and the usage of vasoactive drug administrations were compared between the two groups.Results Compared with the etomidate group,the AUCMAP-(145.10±35.75 vs.178.52±39.78)and AUCHR-[43.20(26.58,56.35)vs.54.99(43.01,65.85)]in remimazolam tosylate group were significantly reduced(P＜0.001,P=0.001).The time to loss of consciousness and the time from the start of anesthesia induction to BIS＜60 were prolonged(P＜0.001).The incidence of drug-related adverse reactions was significantly decreased(P＜0.05),and the number of norepinephrine administrations was significantly reduced(P＜0.05)in remimazolam tosylate group.However,there were no statistically significant differences in AUCMAP+,AUCHR+,the incidence of cardiovascular adverse events,and the usages of atropine,urapidil,and esmolol between the two groups(P＞0.05).Conclusion The use of remimazolam tosylate during anesthesia induction in elderly frail patients can provide more stable hemodynamic parameters and results in fewer adverse reactions than etomidate.
