Effect of lidocaine on dose-effect relationship of remimazolam combined with alfentanil in inhibiting responses to gastroscope insertion in elderly patients
10.3760/cma.j.cn131073.20230523.00711
- VernacularTitle:利多卡因对复合阿芬太尼时瑞马唑仑抑制老年患者胃镜置入反应量效关系的影响
- Author:
Hai XU
1
;
Tinging ZHU
;
Hongmei ZHOU
Author Information
1. 嘉兴市第二医院麻醉科，嘉兴 314000
- Keywords:
Lidocaine;
Benzodiazepines;
Aged;
Gastroscopy;
Dose-response relationship
- From:
Chinese Journal of Anesthesiology
2023;43(7):819-822
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the effect of lidocaine on the dose-effect relationship of remimazolam combined with alfentanil in inhibiting responses to gastroscope insertion in elderly patients.Methods:American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱelderly patients of either sex, aged 65-80 yr, with body mass index of 18-28 kg/m 2, undergoing painless gastroscopy under general anesthesia, were divided into 2 groups using a random number table method: remimazolam group (group C) and lidocaine combined with remimazolam group (group L). Alfentanil 6 μg/kg was given at anesthesia induction in all the patients, and then lidocaine 2 mg/kg was intravenously injected in the patients in group L. Modified Dixon′s up-and-down method was used for the study. Remimazolam was intravenously injected at a dose of 0.18 mg/kg in the first patient, and the gastroscope was placed when the eyelash reflex disappeared and the modified observational alertness/sedation assessment score ≤3. Gastroscope insertion response was defined as swallowing, bucking, body movement and other responses affecting the quality of examination during the gastroscope insertion. The dose of remimazolam was increased/decreased by 0.02 mg/kg in the next patient if the gastroscope response was positive or negative, and the process was repeated until 9 turning points occurred. The median effective dose (ED 50) and 95% confidence interval ( CI) of remimazolam were calculated by probit method. Results:The ED 50 (95% CI) of remidazolam in inhibiting responses to gastroscope insertion in elderly patients when combined with alfentanil was 0.158 (0.133-0.183) mg/kg in group C. The ED 50 (95% CI) of remidazolam in inhibiting responses to gastroscope insertion in elderly patients when combined with fentanyl was 0.139 (0.127-0.151) mg/kg in group L. The ED 50 was significantly lower in group L than in group C ( P=0.003). Conclusions:Intravenous lidocaine in combination with alfentanil increases the efficacy of remimazolam for painless gastroscopy in elderly patients.
