Why the study?
Studies had not explored the haemodynamic effects of remimazolam in elderly hypertensive subjects undergoing non-cardiac surgery.
Does remimazolam compared to etomidate improve haemodynamic stability and reduce adverse effects during anaesthesia induction in hypertensive elderly patients undergoing non-cardiac surgery?
Does remimazolam compared to etomidate improve haemodynamic stability and reduce adverse effects during anaesthesia induction in hypertensive elderly patients undergoing non-cardiac surgery?
Low-dose remimazolam (0.2 mg/kg) is an effective alternative to etomidate for anaesthesia induction in elderly hypertensive patients, offering comparable haemodynamic stability with fewer adverse effects such as injection pain and myoclonus.
Answers are grounded in this paper and cite their sources.
Supports low-dose remimazolam for induction in elderly hypertensives; extends RCT evidence versus etomidate with better tolerability.
Background: ) agonist, with several advantages including rapid induction and recovery, stable haemodynamics, and mild respiratory inhibition. However, studies have not been conducted to explore the haemodynamic effects of RT in elderly hypertensive subjects undergoing non-cardiac surgery. Therefore, we sought to compare the effects of anaesthesia induction using different doses of RT and etomidate on the haemodynamics of this group of patients. Methods: Patients were recruited into this single-center, prospective, randomized, double-blind trial from October 2022 to June 2023. A total of 150 hypertensive elderly undergoing non-cardiac surgery were randomly assigned into 0.2 mg/kg RT group (Group RL), 0.3 mg/kg RT group (Group RH) and 0.3 mg/kg etomidate group (Group E). The primary outcome of the study was haemodynamic changes (mean arterial pressure fluctuation value -∆MAP and heart rate fluctuation value -∆HR) observed during anaesthesia induction. Secondary outcomes included incidence of adverse cardiovascular events and adverse drug reactions (injection pain and myoclonus), cumulative doses of vasoactive drugs and vital signs at different time points. Results: Patients in Group E and Group RL had significantly lower haemodynamic fluctuations (∆MAP), lower incidence of hypotension and cumulative dose of ephedrine than subjects in Group RH. Patients in groups RL and RH had significantly lower incidence of injection pain and myoclonus compared with patients in group E. The results showed no statistically significant differences in ∆HR, hypertension, bradycardia, tachycardia, and time to loss of eye-opening reflex and start of intubation, and vital signs at different time points among the three groups. Conclusion: Use of low-dose RT (0.2 mg/kg) for induction of non-cardiac surgical anaesthesia in elderly hypertensive patients is more effective in maintaining haemodynamic stability and has fewer adverse effects compared with etomidate.
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Chen et al. (2023) studied this question.
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