Application of remimazolam toluene sulfonate combined with paravertebral nerve block in thoracoscopic lobectomy under SEDline monitoring
Li Zhiyi1,2, Ling Yunzhi1, Hong Haining2,3, Sun Yiyun1, Gao Xingyue1,2, Xie Yaqiong1,2
1Department of Anesthesiology, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China; 2Graduate School of Bengbu Medical College, Bengbu 233030, China; 3Department of Thoracic Surgery, the First Affiliated Hospital of Bengbu Medical College Bengbu 233004, China
Abstract:Objective This study aimed to explore the clinical value of remimzolam mesylate combined with thoracic paravertebral nerve block (TPVB) in thoracoscopic lobectomy under the monitoring of a SEDline sedation monitor. Methods A prospective randomized control study was conducted from June 2021 to May 2022. Eighty patients (45 males and 35 females, aged 40-71 years) who underwent thoracoscopic lobectomy in the First Affiliated Hospital of Bengbu Medical College were included. The patients were randomly divided into four groups by using the numerical table method. Among them, remimazolam mesylate intravenous anesthesia combined with TPVB was used as the TR group, remimazolam mesylate intravenous anesthesia was the R group, propofol intravenous anesthesia combined with TPVB was TB group, and propofol intravenous anesthesia was the B group, with 20 patients in each group. All patients underwent thoracoscopic lobectomy under the monitoring of a SEDline sedation monitor. During the operation, the anesthesia dosage was adjusted according to the patient's brain state index (PSI), which was maintained at 25-50. The observation indices were as follows. (1) The clinical baseline data of the four groups, including gender, age, body mass index (BMI), preoperative serum homocysteine (Hcy), and preoperative cognitive function score of the Mini Mental State Examination (MMSE) were compared. (2) Percutaneous arterial oxygen saturation (SPO2), heart rate, mean arterial pressure (MAP), serum malondialdehyde (MDA), and advanced oxidation protein product (AOPP) were recorded and compared before anesthesia induction (T0), at skin incision (T1), after 30 min of one lung ventilation (T2), and immediately after operation (T3) in the four groups. (3) The operation time, intraoperative infusion volume, bleeding volume, and remifentanil hydrochloride dosage of the four groups were recorded and compared. (4) The visual analog scale (VAS) score of pain and Ramsay sedation score at 6 and 24 h after operation were compared, and the serum Hcy level, MMSE cognitive function score, and times of pressing analgesia pump at 24 h after operation were compared. Results (1) No significant difference existed in clinical baseline data such as gender, age, BMI, preoperative Hcy, and preoperative MMSE score among the four groups (all P values >0.05). (2) The indices were compared at different time points in the group. Results showed that the heart rate of group R significantly differed at various time points (F=3.30, P=0.025), whereas the heart rate of group TR, TB, and B did not significantly differ at various time points (all P values >0.05). MAP, SPO2, MDA, and AOPP in the four groups significantly differed at various time points (all P values <0.05). Comparison between groups was also made at different time points. Results showed that at T0, no significant difference existed in MAP, heart rate, SPO2, MDA, and AOPP among the four groups (all P values >0.05). At T1 and T2, the difference in heart rate, MDA, and AOPP was statistically significant (all P values <0.05). The heart rate of the TB group was the lowest, whereas that of the TR group was the lowest. No significant difference existed in MAP and SPO2 (all P values >0.05). At T3, the difference in MAP, MDA, and AOPP was statistically significant (all P values <0.05). MAP in the B group was the lowest, whereas MDA and AOPP in the TR group were the lowest. No significant difference existed in heart rate and SPO2 (all P values >0.05). (3) The dosage of remifentanil hydrochloride during operation in the four groups was less in the TR and TB groups but was greater in the R and B groups, with a statistically significant difference (F=23.67, P <0.001). The operation time and intraoperative infusion volume were also analyzed. Results showed no significant difference in the amount of bleeding (all P values >0.05). (4) Significant difference existed among the four groups in terms of pain VAS score and Ramsay sedation score 6 and 24 h after operation, as well as the level of serum Hcy, MMSE cognitive function score, and number of times of pressing analgesia pump 24 h after operation (all P values <0.05). Conclusion Remimazolam toluenesulfonate combined with TPVB can more accurately control the anesthesia state during thoracoscopic lobectomy, and the patient's circulation fluctuation range was small. Accordingly, the sedation and analgesia effects after operation were more advantageous.
李芷依, 凌云志, 洪海宁, 孙宜云, 高兴悦, 谢亚琼. SEDline镇静监测下瑞马唑仑静脉麻醉联合胸椎旁神经阻滞在胸腔镜肺叶切除术中的应用[J]. 中华解剖与临床杂志, 2023, 28(4): 262-268.
Li Zhiyi, Ling Yunzhi, Hong Haining, Sun Yiyun, Gao Xingyue, Xie Yaqiong. Application of remimazolam toluene sulfonate combined with paravertebral nerve block in thoracoscopic lobectomy under SEDline monitoring. Chinese Journal of Anatomy and Clinics, 2023, 28(4): 262-268.
Lim E, Batchelor T, Shackcloth M, et al.Study protocol for VIdeo assisted thoracoscopic lobectomy versus conventional Open LobEcTomy for lung cancer, a UK multicentre randomised controlled trial with an internal pilot (the VIOLET study)[J]. BMJ Open, 2019,9(10):e029507. DOI: 10.1136/bmjopen-2019-029507.
[2]
Hung MH, Chan KC, Liu YJ, et al.Nonintubated thoracoscopic lobectomy for lung cancer using epidural anesthesia and intercostal blockade: a retrospective cohort study of 238 cases[J]. Medicine (Baltimore), 2015,94(13):e727. DOI: 10.1097/MD.0000000000000727.
[3]
Wang L, Zhang A, Liu W, et al.Effects of dexmedetomidine on perioperative stress response, inflammation and immune function in patients with different degrees of liver cirrhosis[J]. Exp Ther Med, 2018,16(5):3869-3874. DOI: 10.3892/etm.2018.6665.
[4]
赵秀凤, 刘川. 超声引导下胸椎旁阻滞在胸腔镜肺叶切除术中的应用[J]. 现代医药卫生, 2019,35(13):1978-1980,1983.DOI: 10.3969/j.issn.1009-5519.2019.13.018.Zhao FX, Liu C.Application of ultrasound-guided paravertebral block in thoracoscopic pulmonary lobectomy[J]. Journal of Modern Medicine & Health. 2019,35(13):1978-1980,1983.DOI: 10.3969/j.issn.1009-5519.2019.13.018.
Turhan Ö, Sivrikoz N, Sungur Z, et al.Thoracic paravertebral block achieves better pain control than erector spinae plane block and intercostal nerve block in thoracoscopic surgery: a randomized study[J]. J Cardiothorac Vasc Anesth, 2021,35(10):2920-2927. DOI: 10.1053/j.jvca.2020.11.034.
[7]
罗凯, 符黄德, 姚洁民. 瑞马唑仑临床应用的研究进展[J]. 中华重症医学电子杂志, 2021,7(1):71-75. DOI: 10.3877/cma.j.issn.2096-1537.2021.01.012.Luo K, Fu HD, Yao JM.Review on latest clinical practice of Remimazolam[J]. Chinese Journal of Critical Care & Intensive Care Medicine (Electronic Edition), 2021,7(1):71-75. DOI: 10.3877/cma.j.issn.2096-1537.2021.01.012.
[8]
童珊珊, 闵苏. 新型镇静药瑞马唑仑的临床研究进展[J]. 中国新药与临床杂志, 2021,40(5):351-355.DOI:10.14109/j.cnki.xyylc.2021.05.06.Tong SS,Min S.Research progress of new sedative drug remimazolam in clinical application[J]. Chinese Journal of New Drugs and Clinical Remedies, 2021,40(5):351-355. DOI:10.14109/j.cnki.xyylc.2021.05.06.
[9]
Lee A, Shirley M.Remimazolam: a review in procedural sedation[J]. Drugs, 2021,81(10):1193-1201. DOI: 10.1007/s40265-021-01544-8.
[10]
Goudra B, Singh PM, Gouda G, et al.Propofol and non-propofol based sedation for outpatient colonoscopy-prospective comparison of depth of sedation using an EEG based SEDLine monitor[J]. J Clin Monit Comput, 2016,30(5):551-557. DOI: 10.1007/s10877-015-9769-5.
[11]
Jones JH, Nittur VR, Fleming N, et al.Simultaneous comparison of depth of sedation performance between SedLine and BIS during general anesthesia using custom passive interface hardware: study protocol for a prospective, non-blinded, non-randomized trial[J]. BMC Anesthesiol, 2021,21(1):105. DOI: 10.1186/s12871-021-01326-5.
[12]
Orsini J, Nadkarni A, Chen J, et al.Propofol infusion syndrome: case report and literature review[J]. Am J Health Syst Pharm, 2009,66(10):908-915. DOI: 10.2146/ajhp070605.
[13]
Kilpatrick GJ, McIntyre MS, Cox RF, et al. CNS 7056: a novel ultra-short-acting Benzodiazepine[J]. Anesthesiology, 2007, 107(1): 60-66. DOI: 10.1097/01.anes.0000267503.85085.c0.
[14]
Karagülle M, Kardeş S, Karagülle O, et al.Effect of spa therapy with saline balneotherapy on oxidant/antioxidant status in patients with rheumatoid arthritis: a single-blind randomized controlled trial[J]. Int J Biometeorol, 2017, 61(1): 169-180. DOI: 10.1007/s00484-016-1201-4.
[15]
Larsen JR, Torp P, Norrild K, et al.Propofol reduces tissue-Doppler markers of left ventricle function: a transthoracic echocardiographic study[J]. Br J Anaesth, 2007, 98(2): 183-188. DOI: 10.1093/bja/ael345.
[16]
李会新, 邢飞, 张卫, 等. 瑞马唑仑和丙泊酚对目标导向血流动力学管理策略老年患者术后恢复质量影响的比较[J]. 中华麻醉学杂志, 2021, 41(12): 1433-1436. DOI:10.3760/cma.j.cn131073.20210902.01206.Li HX, Xing F, Zhang W, et al.Comparison of the effects of Remazolam and propofol on quality of postoperative recovery in aged patients with goal-directed hemodynamic management strategies[J]. Chinese Journal of Anesthesiology, 2021, 41(12): 1433-1436. DOI:10.3760/cma.j.cn131073.20210902.01206.
[17]
Troen A, Rosenberg I.Homocysteine and cognitive function[J]. Semin Vasc Med, 2005,5(2):209-214. DOI: 10.1055/s-2005-872406.
[18]
Smith AD, Refsum H, Bottiglieri T, et al.Homocysteine and dementia: an international consensus statement[J]. J Alzheimers Dis, 2018,62(2):561-570. DOI: 10.3233/JAD-171042.
[19]
Rasheed AM, Amirah MF, Abdallah M, et al.Ramsay sedation scale and richmond agitation sedation scale: a cross-sectional study[J]. Dimens Crit Care Nurs, 2019, 38(2): 90-95. DOI: 10.1097/DCC.0000000000000346.
[20]
Jia X, Wang Z, Huang F, et al.A comparison of the mini-mental state examination (MMSE) with the Montreal cognitive assessment (MoCA) for mild cognitive impairment screening in Chinese middle-aged and older population: a cross-sectional study[J]. BMC Psychiatry, 2021,21(1):485. DOI: 10.1186/s12888-021-03495-6.