주요 척추 수술 중 레미마졸람 또는 프로포폴 전정맥마취가 혈역학적 안정성에 미치는 영향의 비교

Abstract

Abstract

Introduction: Perioperative hypotension has been linked to negative perioperative outcomes. In this study, we compared the effects of remimazolam and propofol-based total intravenous general anesthesia on intraoperative hemodynamic stability in patients undergoing surgeries in the prone position. Methods: In this randomized controlled study, patients undergoing major spinal surgery in the prone position were randomly assigned to the propofol and remimazolam groups. Target-controlled infusion (1.5-3 μg/mL) was used for the induction and maintenance of anesthesia in the propofol group and continuous infusion (6 mg/kg/hr for induction and 0.5-2 mg/kg/hr for maintenance) was used in the remimazolam group, with target-controlled infusion of remifentanil at a rate of 3-5 ng/mL in both groups. The primary outcomes of this study were the incidence of hypotensive and severe hypotensive episodes, and the total amount of inotropic or vasopressor medication used to maintain hemodynamic stability for one hour after prone positioning. The secondary outcomes included systolic and mean arterial pressure, heart rate, cardiac index and output, stroke volume, stroke volume variation, and pleth variability index. All variables were recorded each minute for the first 10 minutes after prone positioning, and every 10 minutes thereafter. Results: Among the 94 enrolled patients (47 patients in each group), the results indicated no significant difference in the incidence of hypotensive or severe hypotensive events 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 less in the remimazolam group (p=0.020) and the mean arterial pressure during the initial 10 minutes after prone positioning was higher in the remimazolam group (p=0.003). Conclusion: These findings suggest that remimazolam may be a better option than propofol for preserving mean arterial pressure during spinal surgery in the immediate period following prone positioning.