Observation on the application effect of remimazolam on elderly patients undergoing heart valve replacement surgery under cardiopulmonary bypass

FAN Qing; ZHU Shuangshuang; MENG Huifang; ZHANG Xungong

doi:10.3969/j.issn.1674-3806.2024.02.09

Abstract：Objective To observe the application effect of remimazolam on elderly patients undergoing heart valve replacement surgery under cardiopulmonary bypass(CPB).Methods Three hundred and thirty-four elderly patients admitted to People's Hospital of Zhengzhou for elective cardiac valve replacement surgery under CPB from June 2022 to June 2023 were recruited and divided into remimazolam group(group R)and propofol group(group P)by random number table method,with 167 cases in each group,and according to the exclusion criteria,160 and 159 cases were finally included in the group R and the group P,respectively.The group R was injected with remimazolam intravenously at 0.2-0.3 mg/kg during anesthesia induction,and was pumped with remimazolam intravenously at 0.5-1.0 mg/(kg·h)during anesthesia maintenance.The group P was injected with propofol intravenously at 1.0-2.0 mg/kg during anesthesia induction,and was pumped with propofol intravenously at 4-10 mg/(kg·h)during anesthesia maintenance.The rest of the anesthesia induction and maintenance were consistent in both groups.The occurrence of postoperative delirium(POD)was assessed by using confusion assessment method-intensive care unit(CAM-ICU)within 3 days after surgery.The indicators related to surgery and anesthesia,the occurrence of POD,Visual Analogue Scale(VAS)score,Ramsay Sedation Scale score,and intraoperative and postoperative adverse events were compared between the two groups.Results Compared with those in the group P,the patients in the group R had shorter postoperative anesthesia recovery time,shorter tracheal catheter removal time,shorter intensive care unit(ICU)stay time and hospital stay time,and the differences were statistically significant(P＜0.05).There were no significant differences in the incidence rate,severity and duration of POD between the two groups(P＞0.05).There were no significant differences in the postoperative VAS scores and Ramsay Sedation Scale scores between the two groups(P＞0.05)at postoperative different time points.The incidence rates of intraop-erative sinus bradycardia and hypotension in the group R were lower than those in the group P,and the differences were statistically significant(P＜0.05).Conclusion Compared with that of propofol,the application of remimazolam in the induction and maintenance of general anesthesia in elderly patients undergoing heart valve replacement surgery under CPB does not increase the incidence rate of POD,and it is safe and helpful for rapid postoperative recovery of the patients.