Cargando…

Comparison of Remimazolam Tosilate and Etomidate on Hemodynamics in Cardiac Surgery: A Randomised Controlled Trial

BACKGROUND: Remimazolam tosilate (RT) is a new ultrashort-acting γ-aminobutyric acid subtype A (GABA(A)) agonist, with the characteristics of rapid onset and offset, minimal cardiorespiratory depression. Currently, few studies have compared the effect of RT and etomidate on hemodynamics during anest...

Descripción completa

Detalles Bibliográficos
Autores principales: Hu, Bailong, Zhang, Mei, Wu, Zhen, Zhang, Xiaoyuan, Zou, Xiaohua, Tan, Li, Song, Tao, Li, Xingyu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922514/
https://www.ncbi.nlm.nih.gov/pubmed/36789096
http://dx.doi.org/10.2147/DDDT.S401969
_version_ 1784887551832621056
author Hu, Bailong
Zhang, Mei
Wu, Zhen
Zhang, Xiaoyuan
Zou, Xiaohua
Tan, Li
Song, Tao
Li, Xingyu
author_facet Hu, Bailong
Zhang, Mei
Wu, Zhen
Zhang, Xiaoyuan
Zou, Xiaohua
Tan, Li
Song, Tao
Li, Xingyu
author_sort Hu, Bailong
collection PubMed
description BACKGROUND: Remimazolam tosilate (RT) is a new ultrashort-acting γ-aminobutyric acid subtype A (GABA(A)) agonist, with the characteristics of rapid onset and offset, minimal cardiorespiratory depression. Currently, few studies have compared the effect of RT and etomidate on hemodynamics during anesthesia induction. Here, we aimed to compare the hemodynamic effects of different doses of RT and etomidate for anesthesia induction in patients undergoing cardiac surgeries. METHODS: Patients were recruited from January to September 2022 in this single-center, prospective, randomized, double-blind trial. A total of 117 patients undergoing selective valve replacement surgery were randomly divided into low-dose RT (0.2 mg/kg) group (group LR), high-dose RT (0.3 mg/kg) group (group HR), or etomidate (1.5 mg/kg) group (group E), respectively. The primary outcome was hemodynamic fluctuations (mean arterial pressure fluctuation value [∆MAP]; heart rate fluctuation value [∆HR]) during anesthesia induction. Secondary outcomes included the incidence of adverse drug reactions (injection pain and myoclonus) and adverse cardiovascular events, vital signs at different time points and the cumulative doses of vasoactive drugs. RESULTS: The hemodynamic fluctuations (∆MAP) in group LR and group E were significantly lower than that in group HR. In addition, the incidence of hypotension and the cumulative norepinephrine doses in group E and group LR were also significantly lower than that in group HR. Furthermore, the incidence of injection pain and myoclonus in group LR and group HR were less frequently recorded compared with group E. There were no significant differences in terms of ∆HR, tachycardia, hypertension, severe bradycardia, vital signs at different time points, lactic acid and blood glucose between both groups. CONCLUSION: Compared with etomidate, low-dose RT (0.2mg/kg) can not only provide stable hemodynamic parameters but also cause fewer adverse reactions when used for anesthesia induction in patients with cardiac disease.
format Online
Article
Text
id pubmed-9922514
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Dove
record_format MEDLINE/PubMed
spelling pubmed-99225142023-02-13 Comparison of Remimazolam Tosilate and Etomidate on Hemodynamics in Cardiac Surgery: A Randomised Controlled Trial Hu, Bailong Zhang, Mei Wu, Zhen Zhang, Xiaoyuan Zou, Xiaohua Tan, Li Song, Tao Li, Xingyu Drug Des Devel Ther Original Research BACKGROUND: Remimazolam tosilate (RT) is a new ultrashort-acting γ-aminobutyric acid subtype A (GABA(A)) agonist, with the characteristics of rapid onset and offset, minimal cardiorespiratory depression. Currently, few studies have compared the effect of RT and etomidate on hemodynamics during anesthesia induction. Here, we aimed to compare the hemodynamic effects of different doses of RT and etomidate for anesthesia induction in patients undergoing cardiac surgeries. METHODS: Patients were recruited from January to September 2022 in this single-center, prospective, randomized, double-blind trial. A total of 117 patients undergoing selective valve replacement surgery were randomly divided into low-dose RT (0.2 mg/kg) group (group LR), high-dose RT (0.3 mg/kg) group (group HR), or etomidate (1.5 mg/kg) group (group E), respectively. The primary outcome was hemodynamic fluctuations (mean arterial pressure fluctuation value [∆MAP]; heart rate fluctuation value [∆HR]) during anesthesia induction. Secondary outcomes included the incidence of adverse drug reactions (injection pain and myoclonus) and adverse cardiovascular events, vital signs at different time points and the cumulative doses of vasoactive drugs. RESULTS: The hemodynamic fluctuations (∆MAP) in group LR and group E were significantly lower than that in group HR. In addition, the incidence of hypotension and the cumulative norepinephrine doses in group E and group LR were also significantly lower than that in group HR. Furthermore, the incidence of injection pain and myoclonus in group LR and group HR were less frequently recorded compared with group E. There were no significant differences in terms of ∆HR, tachycardia, hypertension, severe bradycardia, vital signs at different time points, lactic acid and blood glucose between both groups. CONCLUSION: Compared with etomidate, low-dose RT (0.2mg/kg) can not only provide stable hemodynamic parameters but also cause fewer adverse reactions when used for anesthesia induction in patients with cardiac disease. Dove 2023-02-08 /pmc/articles/PMC9922514/ /pubmed/36789096 http://dx.doi.org/10.2147/DDDT.S401969 Text en © 2023 Hu et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Original Research
Hu, Bailong
Zhang, Mei
Wu, Zhen
Zhang, Xiaoyuan
Zou, Xiaohua
Tan, Li
Song, Tao
Li, Xingyu
Comparison of Remimazolam Tosilate and Etomidate on Hemodynamics in Cardiac Surgery: A Randomised Controlled Trial
title Comparison of Remimazolam Tosilate and Etomidate on Hemodynamics in Cardiac Surgery: A Randomised Controlled Trial
title_full Comparison of Remimazolam Tosilate and Etomidate on Hemodynamics in Cardiac Surgery: A Randomised Controlled Trial
title_fullStr Comparison of Remimazolam Tosilate and Etomidate on Hemodynamics in Cardiac Surgery: A Randomised Controlled Trial
title_full_unstemmed Comparison of Remimazolam Tosilate and Etomidate on Hemodynamics in Cardiac Surgery: A Randomised Controlled Trial
title_short Comparison of Remimazolam Tosilate and Etomidate on Hemodynamics in Cardiac Surgery: A Randomised Controlled Trial
title_sort comparison of remimazolam tosilate and etomidate on hemodynamics in cardiac surgery: a randomised controlled trial
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922514/
https://www.ncbi.nlm.nih.gov/pubmed/36789096
http://dx.doi.org/10.2147/DDDT.S401969
work_keys_str_mv AT hubailong comparisonofremimazolamtosilateandetomidateonhemodynamicsincardiacsurgeryarandomisedcontrolledtrial
AT zhangmei comparisonofremimazolamtosilateandetomidateonhemodynamicsincardiacsurgeryarandomisedcontrolledtrial
AT wuzhen comparisonofremimazolamtosilateandetomidateonhemodynamicsincardiacsurgeryarandomisedcontrolledtrial
AT zhangxiaoyuan comparisonofremimazolamtosilateandetomidateonhemodynamicsincardiacsurgeryarandomisedcontrolledtrial
AT zouxiaohua comparisonofremimazolamtosilateandetomidateonhemodynamicsincardiacsurgeryarandomisedcontrolledtrial
AT tanli comparisonofremimazolamtosilateandetomidateonhemodynamicsincardiacsurgeryarandomisedcontrolledtrial
AT songtao comparisonofremimazolamtosilateandetomidateonhemodynamicsincardiacsurgeryarandomisedcontrolledtrial
AT lixingyu comparisonofremimazolamtosilateandetomidateonhemodynamicsincardiacsurgeryarandomisedcontrolledtrial