Title : Comparison of remimazolam and propofol for rescue treatment for acute tolerance to the EEG effect of propofol on total intravenous anesthesia
Abstract:
Background: Propofol is the most widely used agent for total intravenous anestghesia(TIVA) by anesthesiologists.There are remained some reports that the continuous use of propofol in the total intravenous anesthesia(TIVA) induce acute tolerence to the EEG effect.Remimazolam is a new short-acting GABA-A receptor agonist. It is an ester-based benzodiazepine. This meta-analysis aims to clarify the efficacy and safety of remimazolam versus propofol for rescue treatment for the situation of acute tolerance on TIVA anesthesia on the EEG effect.
Method: Surgical patients(n=100) who started to anesthetized with propofol TIVA and had the event of BIS score more than 60 were selected.The adding of rescue medication were randomized to two group. Adding remimazolam(R group) started at 6mg/kg/h by continuous intravenous (IV) infusion until the BIS score down to 60, followed by adding 1 mg/kg/h to be adjusted as appropriate until the end of surgery Adding propofol(P group) administered as a slow bolus of 2.0-2.5 mg/kg until BIS down to 60 followed by continuous infusion of adding 4-10 mg/kg/h until the end of surgery.Efficacy was measured via the total time for reaching BIS <60, no need for rescue sedatives.When MAP was under 65, vasoconstrictive drug was injected(Propofol was anesthetized with 4mcg/ml of propofol effect-site concentration(Ce with target-control infusion, followed by 2.5~3mcg/mL of Ce)
Result: The time to reach to BIS under 60 was shoter in R group than P group(R group 2min +- 30sec , P group 5min +- 30sec p<0.05)Decreased blood pressure occurred in 21% of patients treated with R group compared with 48% of patients receiving propofol, which induced the use of vasoconstrictive drug which frequencies were 10%, 35%
Conclusion: This study showed remimazolam for rescue treatment was superior than adding propofol for acute tolerence on EEG effect.
