Effect of Remimazolam- versus Propofol-Based Total Intravenous General Anesthesia on Intraoperative Hemodynamic Stability for Major Spine Surgery in the Prone Position: A Randomized Controlled Trial
<i>Background and Objectives</i>: Remimazolam offers advantages over propofol in terms of hemodynamic stability. However, it remains unclear whether remimazolam-based total intravenous anesthesia (TIVA) can reduce intraoperative hypotension compared to propofol-based TIVA, especially aft...
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MDPI AG
2024-03-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/60/3/432 |
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| author | Ha-Jung Kim Ji-Young Kim Hyeok-Seong Park Hyungtae Kim Young-Jin Ro Won Uk Koh |
| author_facet | Ha-Jung Kim Ji-Young Kim Hyeok-Seong Park Hyungtae Kim Young-Jin Ro Won Uk Koh |
| author_sort | Ha-Jung Kim |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Remimazolam offers advantages over propofol in terms of hemodynamic stability. However, it remains unclear whether remimazolam-based total intravenous anesthesia (TIVA) can reduce intraoperative hypotension compared to propofol-based TIVA, especially after prone positioning. In this study, we compared the effects of remimazolam- and propofol-based TIVA on intraoperative hemodynamic stability in patients undergoing surgery in the prone position. <i>Materials and Methods</i>: This study randomly assigned patients undergoing major spinal surgery in the prone position to the propofol or remimazolam group. Target-controlled infusion (2–3.5 μg/mL for induction and 2–3 μg/mL for maintenance) was used in the propofol group and continuous infusion (6 mg/kg/h for induction and 1–2 mg/kg/h for maintenance) was used in the remimazolam group; target-controlled infusion (3–5 ng/mL) of remifentanil was performed in both groups. The primary outcomes were the incidence of hypotensive episodes during the first hour after prone positioning. The secondary outcomes included the incidence of severe hypotension and the total amount of inotropic or vasopressor medication. Systolic and mean arterial pressure, heart rate, cardiac index and output, stroke volume, stroke volume variation, and pleth variability index were also evaluated. These variables were recorded per minute for the first 10 min after prone positioning, and every 10 min thereafter. <i>Results</i>: The study enrolled 94 patients (47 patients in each group). The incidence of hypotension or severe hypotension did not differ significantly between the two groups during the first hour after prone positioning. The total amount of ephedrine administered during the first hour after prone positioning was lesser (<i>p</i> = 0.020) and the mean arterial pressure during the initial 10 min after prone positioning was higher in the remimazolam group (<i>p</i> = 0.003). <i>Conclusions</i>: Our study uncovered no significant differences in the incidence of hypotension between remimazolam- and propofol-based TIVA in patients undergoing major spine surgery in prone position. |
| first_indexed | 2024-04-24T18:02:01Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-04-24T18:02:01Z |
| publishDate | 2024-03-01 |
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| series | Medicina |
| spelling | doaj.art-d4aa2ee237184d71b93a661e0071e37f2024-03-27T13:53:37ZengMDPI AGMedicina1010-660X1648-91442024-03-0160343210.3390/medicina60030432Effect of Remimazolam- versus Propofol-Based Total Intravenous General Anesthesia on Intraoperative Hemodynamic Stability for Major Spine Surgery in the Prone Position: A Randomized Controlled TrialHa-Jung Kim0Ji-Young Kim1Hyeok-Seong Park2Hyungtae Kim3Young-Jin Ro4Won Uk Koh5Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of KoreaDepartment of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of KoreaDepartment of Anesthesiology and Pain Medicine, Shihwa Medical Center, Siheung 15034, Republic of KoreaDepartment of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of KoreaDepartment of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of KoreaDepartment of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea<i>Background and Objectives</i>: Remimazolam offers advantages over propofol in terms of hemodynamic stability. However, it remains unclear whether remimazolam-based total intravenous anesthesia (TIVA) can reduce intraoperative hypotension compared to propofol-based TIVA, especially after prone positioning. In this study, we compared the effects of remimazolam- and propofol-based TIVA on intraoperative hemodynamic stability in patients undergoing surgery in the prone position. <i>Materials and Methods</i>: This study randomly assigned patients undergoing major spinal surgery in the prone position to the propofol or remimazolam group. Target-controlled infusion (2–3.5 μg/mL for induction and 2–3 μg/mL for maintenance) was used in the propofol group and continuous infusion (6 mg/kg/h for induction and 1–2 mg/kg/h for maintenance) was used in the remimazolam group; target-controlled infusion (3–5 ng/mL) of remifentanil was performed in both groups. The primary outcomes were the incidence of hypotensive episodes during the first hour after prone positioning. The secondary outcomes included the incidence of severe hypotension and the total amount of inotropic or vasopressor medication. Systolic and mean arterial pressure, heart rate, cardiac index and output, stroke volume, stroke volume variation, and pleth variability index were also evaluated. These variables were recorded per minute for the first 10 min after prone positioning, and every 10 min thereafter. <i>Results</i>: The study enrolled 94 patients (47 patients in each group). The incidence of hypotension or severe hypotension did not differ significantly between the two groups during the first hour after prone positioning. The total amount of ephedrine administered during the first hour after prone positioning was lesser (<i>p</i> = 0.020) and the mean arterial pressure during the initial 10 min after prone positioning was higher in the remimazolam group (<i>p</i> = 0.003). <i>Conclusions</i>: Our study uncovered no significant differences in the incidence of hypotension between remimazolam- and propofol-based TIVA in patients undergoing major spine surgery in prone position.https://www.mdpi.com/1648-9144/60/3/432perioperative hypotensionprone positionpropofolremimazolamspinal surgery |
| spellingShingle | Ha-Jung Kim Ji-Young Kim Hyeok-Seong Park Hyungtae Kim Young-Jin Ro Won Uk Koh Effect of Remimazolam- versus Propofol-Based Total Intravenous General Anesthesia on Intraoperative Hemodynamic Stability for Major Spine Surgery in the Prone Position: A Randomized Controlled Trial Medicina perioperative hypotension prone position propofol remimazolam spinal surgery |
| title | Effect of Remimazolam- versus Propofol-Based Total Intravenous General Anesthesia on Intraoperative Hemodynamic Stability for Major Spine Surgery in the Prone Position: A Randomized Controlled Trial |
| title_full | Effect of Remimazolam- versus Propofol-Based Total Intravenous General Anesthesia on Intraoperative Hemodynamic Stability for Major Spine Surgery in the Prone Position: A Randomized Controlled Trial |
| title_fullStr | Effect of Remimazolam- versus Propofol-Based Total Intravenous General Anesthesia on Intraoperative Hemodynamic Stability for Major Spine Surgery in the Prone Position: A Randomized Controlled Trial |
| title_full_unstemmed | Effect of Remimazolam- versus Propofol-Based Total Intravenous General Anesthesia on Intraoperative Hemodynamic Stability for Major Spine Surgery in the Prone Position: A Randomized Controlled Trial |
| title_short | Effect of Remimazolam- versus Propofol-Based Total Intravenous General Anesthesia on Intraoperative Hemodynamic Stability for Major Spine Surgery in the Prone Position: A Randomized Controlled Trial |
| title_sort | effect of remimazolam versus propofol based total intravenous general anesthesia on intraoperative hemodynamic stability for major spine surgery in the prone position a randomized controlled trial |
| topic | perioperative hypotension prone position propofol remimazolam spinal surgery |
| url | https://www.mdpi.com/1648-9144/60/3/432 |
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