Comparison of the quality of recovery after gastrostomy in patients with amyotro-phic lateral sclerosis receiving remimazolam and propofol
GONG Jing
WANG Jianzhong
CHEN Xiaobo
SHU Aihua
ZHOU Mi
LI Tingting
LUO Junjie
Abstract：Objective To investigate the safety and efficacy of remimazolam in anesthesia induction and maintenance of percutaneous endoscopic gastrostomy(PEG)in patients with amyotrophic lateral sclerosis(ALS)and its effect on postoperative respiratory recovery.Methods A total of 64 patients with ALS,aged 35-65 years,weighing 32-60 kg,ASA Ⅱ or Ⅲ,in the Yichang Central People's Hospital from March 2021 to June 2023 were randomly divided into the remimazolam group(n=32)and the propofol group(n=32).Remimazolam and remifentanil were used in the remimazolam group,and propofol and remifentanil were used in the propofol group.The bispectral index(BIS)was continuously monitored during the operation,and the drug pump dose was adjusted according to the BIS value,and the BIS value was maintained between 40-60 during the operation.All anesthetic drugs were stopped at the end of the operation in both groups.The mean arterial pressure(MAP)and heart rate(HR)of the patients after stable entry were recorded as the basic control values.Meanwhile,the time of induction of anesthesia,the MAP and HR at the time of endotracheal intubation(T1),the time of surgical incision(T2),5 min after the start of surgery(T3),and 10 min after recovery(T4)were recorded.The quality of postoperative recovery,including eye opening time,extubation time,PACU observation time and Steward score of patients transferred out of PACU were recorded in 2 groups.Diaphragm movement amplitude(DM),diaphragm thickness change rate(DTF)and the operating time of non-invasive ventilator 72 h postoperatively were recorded by ultrasonography 1h after surgery.The times of application of vasoactive drugs and the occurrence of adverse reactions were recorded.QoR-15 scale was used to record the recovery index scores of the patients at 24 h,48 h and 72 h after surgery.Results Compared with the propofol group at T1,T2 and T3,the difference of MAP and HR in the remimazolam group was less,and the difference was statistically significant(P＜0.05).The eye opening time,extubation time and PACU observation time of the remimazolam group were shorter than those of the propofol group,with statistical significance(P＜0.05).The change rate of diaphragm movement amplitude and diaphragm thickness in the remimazolam group was higher than that in the propofol group immediately after recovery(T4)and 1 h after surgery;the use time of noninvasive ventilator 72 h after operation was shorter than that of the propofol group;the times of vasopressors applied in the remimazolam group was less than that in the propofol group,and the difference between the two groups was statistically significant(P＜0.05).The cases of dizziness and lethargy in the remimazolam group were less than those in the propofol group(P＜0.05).Patients in the remimazolam group had higher QoR-15 scores 24 h and 48 h after surgery,with statistical significance(P＜0.05).Conclusion Remimazolam is safe and effective in ALS patients,and can meet the anesthesia requirements of gastrostomy,with more stable intraoperative hemodynamics,faster postoperative respiratory function recovery,better short-term recovery quality,fewer anesthesia complications,and higher postoperative recovery quality.
Keywords：remimazolampropofolamyotrophic lateral sclerosispercutaneous endoscopic gastrostomyquality of anesthesia recovery
Publication Date：2024-10-15
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 264-269 )