全身麻醒期间反响丧失和恢复时瑞马唑仑的效应室浓度：一项模仿研究

做者：米勒之声

全身麻醒期间反响丧失和恢复时瑞马唑仑的效应室浓度：一项模仿研究

贵州医科大学 麻醒与心脏电心理课题组

翻译: 安丽 编纂：潘志军 审校：曹莹

布景:瑞马唑仑是新型的一种超短效苯二氮卓类药物，与目前利用的催眠药比拟，它具有起效快、感化时间短，可逆转和庇护血活动力学不变等长处，被越来越多地被用做全凭静脉麻醒(TIVA)。因为那些药理学特征，准确掌握瑞马唑仑浓度在麻醒施行中运用是有益的。本研究的目标是通过模仿全麻患者反响丧失(LOR)和反响恢复(ROR)时瑞马唑仑的效应室浓度(Ce)，研究患者因素与LOR和ROR模仿时Ce之间的关系。

办法：回忆性阐发了2021年8月4日至2021年10月12日期间81例在全身麻醒下利用瑞马唑仑(remimazolam)停止择期手术的患者的医疗笔录。瑞马唑仑以6或12mg/kg/h为诱导剂量赐与患者，曲到患者反响消逝，随后以0.3-2mg/kg/h庇护，以连结BIS值在60以下。利用Asan泵软件模仿手动输注形式，并利用Schüttler模子模仿瑞马唑仑的Ce。无论何时手动改瑞马唑仑的输注速度，几乎同时可确认模仿Ce。在Asan法式平分别笔录了“LOR”和“ROR”时的Ce。

成果：在LOR和ROR时模仿Ce的中位数值（1Q、3Q）别离为0.7（0.5、0.9）和0.3（0.2、0.4）μg/ml。累积打针瑞马唑仑0.3 mg/kg，1.9分钟后到达LOR。年龄与ROR模仿Ce之间存在显著相关性（ROR时模仿Ce=-0.0043×年龄+0.57，r=0.30，P=0.014）。

展开全文

结论：为了调整更佳剂量，在麻醒期间以体重为根底的剂量赐与瑞马唑仑时模仿Ce是有利的。另老年患者可在低的瑞马唑仑Ce下恢复。

原始文献来源：

Kyung Mi Kim, Ji-Yeon Bang, Jong Min Lee, Hong Seuk Yang, Byung-Moon Choi, and Gyu-Jeong Noh.Effect-site concentration of remimazolam at loss and recovery of responsiveness during general anesthesia: a simulation study.Anesth Pain Med 2022;17:262-270.Doi.org/10.17085/apm.21121

英文原文：

Effect-site concentration of remimazolam at loss and recovery of responsiveness during general anesthesia:a simulation study

Abstract

Background: The objective of this study was to investigate the effect-site concentration (Ce) of remimazolam at loss of response (LOR) and recovery of response (ROR) in patients underwent general anesthesia using simulation. In addition, the relationships between patient’s factors and simulated Ce at LOR and ROR were examined.

Methods: The medical records of 81 patients who underwent elective surgery under general anesthesia using remimazolam with simulation of Ce between August 4, 2021 and October 12, 2021, were retrospectively reviewed. Remimazolam was administered as an induction dose of 6 or 12 mg/kg/h until the patient became unresponsive, followed by 0.3–2 mg/kg/h to maintain BIS values below 60. Simultaneously, simulations of manual infusion mode were performed using Asan Pump software and the Ce of remimazolam was simulated using the Schüttler model. Whenever infusion rate of remimazolam was manually changed, the simulated Ce was confirmed almost simultaneously. LOR and ROR, defined as unresponsive and eye-opening to verbal commands, respectively, were recorded in the Asan Pump program.

Results: The median (1Q, 3Q) simulated Ce at LOR and ROR were 0.7 (0.5, 0.9) and 0.3 (0.2, 0.4) μg/ml, respectively. LOR was achieved in 1.9 min after remimazolam infusion with cumulative doses of 0.3 mg/kg. There was a significant relationship between age and simulated Ce at ROR (Ce at ROR = –0.0043 × age + 0.57, r = 0.30, P = 0.014).

Conclusions: For optimal dosage adjustment, simulating Ce while administering remimazolam with a weight-based dose during anesthesia is helpful. Elderly patients may recover from anesthesia at lower Ce of remimazolam.

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