Beneficial Effects of Remimazolam Compared with Dexmedetomidine as an Adjuvant in Total Intravenous Anaesthesia with Propofol and Remifentanil: A Randomised Controlled Trial

TL;DR

This study compares remimazolam and dexmedetomidine as adjuvants in anesthesia, finding that remimazolam reduces propofol use and phenylephrine needs without affecting recovery.

Contribution

The study provides new evidence on remimazolam's propofol-sparing effect and hemodynamic benefits over dexmedetomidine in TIVA.

Findings

The R group required the least propofol, while the C group required the most.

The R group needed significantly less phenylephrine than the D and C groups.

Recovery profiles were similar across all groups.

Abstract

Background and Objectives: The study was designed to compare the propofol-sparing effect, intraoperative haemodynamic profiles, and recovery profiles during propofol–remifentanil total intravenous anaesthesia (TIVA) with remimazolam or dexmedetomidine co-administered as an adjuvant. Materials and Methods: After the remifentanil target concentration of 5 ng/mL had been achieved and endotracheal intubation was completed, the R group was intravenously administered 1 mg remimazolam/kg/hr, the D group was given 0.5 µg dexmedetomidine/kg/hr, and the control (C) group was given 1 mL normal saline/kg/hr. The allocated experimental drug infusion was initiated immediately after intubation and maintained until termination of the two target-controlled infusions of propofol and remifentanil. The propofol-sparing effect, intraoperative haemodynamic profiles and recovery profiles were assessed in the three groups. Results: The R group had the lowest requirement of propofol and the C group had the highest requirement of propofol. Haemodynamic profiles were similar among the groups. However, the total phenylephrine dose administered to maintain haemodynamic stability was significantly lower in the R group than in the D group and C group. Recovery profiles did not significantly differ between the groups. Conclusions: The co-administration of remimazolam or dexmedetomidine as an adjuvant in propofol–remifentanil TIVA reduced propofol requirements. While recovery profiles, including recovery times, postoperative pain, and postoperative nausea and vomiting, were similar among the groups, remimazolam was associated with a reduced phenylephrine requirement despite similar haemodynamic profiles.

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