The safety and efficacy of anesthesia induction and maintenance with remimazolam besylateon in elderly patients undergoing ureteroscopic laser lithotripsy
Authors: Wang Ning , Wang He , Li Yan , Zheng Hong , Shangguan Wangning 
Published: March 2024

Background
Remimazolam is a novel benzodiazepine sedative drug. Studies have confirmed its rapid onset of action, ultra-short duration, and fast recovery time without significant drug-related side effects. However, there is a lack of research on its safety and efficacy of anesthesia induction and maintenance in elderly patients. Therefore, a randomized controlled single-blind study was conducted to investigate its applicaiton in general anesthesia for elderly patients.
Methods
52 elderly patients aged 65 years or older who underwent ureteroscopic lithotripsy were randomized into two groups: the remimazolam group and the propofol group (n = 26 each). Both groups underwent total intravenous anesthesia. Patients in the remimazolam group were induced with a dose of 0.2 mg/kg remimazolam. The propofol group was induced with a dose of 1.8-2.0 mg/kg propofol. When the MOAA/S (Modified Observer's Assessment of Alertness/Sedation) score was equal to or less than 1, sufentanil was administered at a dose of 0.2 µg/kg, and cisatracurium was administered at a dose of 0.1 mg/kg in both groups. The depth of sedation was continuously monitored during the operation using a bispectral index. (BIS). Maintenance of general anesthesia was supplemented with remifentanil in both groups. Intraoperatively, the dose was adjusted according to hemodynamic and BIS results, and vasoactive drugs, mainly phenylephrine and atropine, was administered when necessary. Our primary outcome was the assessment of intraoperative safety indicators, including hemodynamic fluctuations (blood pressure, heart rate, pulse oximetry), as well as the incidence of adverse events such as hypoxemia, arrhythmia, tachycardia, hypertension, and intraoperative awareness. Secondary outcomes included the measurement of induction time and recovery time.
Results
Among the 52 participants enrolled, one participant in the remimazolam group was excluded due to poor laryngeal mask airway ventilation and required tracheal intubation instead. A total of 25 patients in the remimazolam group and 26 patients in the propofol group were analyzed. There were no occurrences of hypoxemia, arrhythmia, tachycardia, hypertension, intraoperative awareness, or any adverse events during the procedures. compared to the propofol group, the remimazolam group displayed a higher median systolic blood pressure after the insertion of the laryngeal mask (P < 0.05). The incidence of a systolic blood pressure (SBP) drop > 20% in the propofol group (50%) was higher than that in the remimazolam group (16%) (P = 0.023). Compared with the remimazolam group, the induction time and recovery time were shorter in the propofol group (93.7 ± 34.5s vs. 20.5 ± 4.6s, P < 0.001; 10.3 ± 5.3min vs. 7.7 ± 2.1min, P = 0.030).
Conclusions
It is feasible to use remimazolam besylate for general anesthesia in elderly patients. The sedation effect is satisfactory, and the induction process is stable. But the recovery time was longer compared to propofol after discontinuation.