Key result
General anesthesia with remimazolam for TAVR required significantly less noradrenaline during maintenance compared to propofol/sevoflurane (0.019 vs 0.042 μg/kg/min; P=0.02) and midazolam/propofol.
Why the study?
Hemodynamics during general anesthesia with remimazolam compared with conventional anesthetics had not been well evaluated in patients with severe aortic stenosis.
Does remimazolam reduce vasopressor use during general anesthesia compared to conventional anesthetics in patients with severe aortic stenosis undergoing TAVR?
Observational (n=42)
No
Does remimazolam reduce vasopressor use during general anesthesia compared to conventional anesthetics in patients with severe aortic stenosis undergoing TAVR?
Absolute Event Rate: 0.019% vs 0.042%
p-value: p=0.02
Remimazolam for induction and maintenance of general anesthesia in patients with severe aortic stenosis undergoing TAVR is associated with significantly less vasopressor use compared to conventional anesthetics.
May reduce vasopressor needs in TAVR anesthesia; hypothesis-generating and requires RCT confirmation before practice change.
Introduction. We compared the hemodynamics during general anesthesia with remimazolam and conventional anesthetics in patients with severe aortic stenosis (AS). Methods. This was a retrospective single‐center analysis. We reviewed the records of 42 patients who underwent transcatheter aortic valve implantation with a transfemoral artery approach under general anesthesia from January to December 2020. Patients were divided into three groups based on the general anesthetic used for (induction/maintenance) remimazolam/remimazolam (Group R/R), propofol/sevoflurane (Group P/S), and midazolam/propofol (Group M/P). Vasopressor use (ephedrine, phenylephrine, and noradrenaline) was compared among the groups. Results. The number of patients in each group was 15 (Group R/R), 13 (Group P/S), and 14 (Group M/P), with no significant difference in background characteristics and intraoperative vital signs. For anesthesia induction, doses of ephedrine and phenylephrine used were significantly lower in Group R/R (ephedrine [mg]: Group R/R 2 [0–4] vs. Group P/S 8 [8–12], P < 0.001, Group R/R vs. Group M/P 5 [0–15], P = 0.39; phenylephrine (mg): Group R/R 0 [0–0.08] vs. Group P/S 0.15 [0.10–0.20], P = 0.03, Group M/P 0.21 [0.04–0.40], P = 0.08). For anesthesia maintenance, the noradrenaline dose used was low in the Group R/R (noradrenaline [μg/kg/min]: Group R/R 0.019 [0.015–0.039], Group P/S 0.042 [0.035–0.045], P = 0.02, Group M/P 0.048 [0.040–0.059], P < 0.01). Conclusion. In patients with severe AS, induction and maintenance of anesthesia with remimazolam resulted in less overall vasopressor use than conventional general anesthetics.
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Miyoshi et al. (2022) conducted an observational in Severe aortic stenosis (n=42). Remimazolam vs. Propofol/sevoflurane or midazolam/propofol was evaluated on Noradrenaline dose (μg/kg/min) during anesthesia maintenance (p=0.02). General anesthesia with remimazolam for TAVR required significantly less noradrenaline during maintenance compared to propofol/sevoflurane (0.019 vs 0.042 μg/kg/min; P=0.02) and midazolam/propofol.
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