Comparison of remimazolam and midazolam for preventing intraoperative nausea and vomiting during cesarean section under spinal anesthesia: a randomized controlled trial.

IF 4.2 4区 医学 Q1 ANESTHESIOLOGY Korean Journal of Anesthesiology Pub Date : 2024-10-08 DOI:10.4097/kja.24311
Kyuho Lee, Seung Ho Choi, Sangil Kim, Hae Dong Kim, Hyejin Oh, Seung Hyun Kim
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Abstract

Background: Preventing intraoperative nausea and vomiting (IONV) is crucial for maternal safety during cesarean section under spinal anesthesia. While midazolam is known to prevent IONV, we hypothesized that remimazolam would be superior due to its minimal hemodynamic effects. We compared the effects of the two drugs on IONV.

Methods: Parturients scheduled for cesarean section were randomly assigned to receive either midazolam or remimazolam. They received midazolam 2 mg or remimazolam 5 mg, with additional doses administered upon request. The primary outcome measure was the incidence of newly developed IONV during sedation. Other outcomes included overall IONV, rescue antiemetic use, shivering, hemodynamic variables, sedation scale scores, and satisfaction scores.

Results: Data from 80 participants were analyzed. Deeper sedation was induced in the remimazolam group (PGroup × Time < 0.001) despite comparable hemodynamic trends between the groups. The incidence of overall IONV was comparable between the two groups (27.5% in the midazolam group vs. 17.5% in the remimazolam group, absolute risk reduction [ARR]: 0.100, 95% confidence interval [CI] [-0.082, 0.282], P = 0.284); however, newly developed IONV during sedation was significantly reduced in the remimazolam group (20.0% vs. 5.0%, ARR: 0.150, 95% CI [0.009, 0.291], P = 0.043). The need for rescue antiemetics was also lower in the remimazolam group (15.0% vs. 2.5%, ARR: 0.125, 95% CI [0.004, 0.246], P = 0.048).

Conclusion: Remimazolam significantly reduced the incidence and severity of newly developed IONV compared with midazolam, with minimal impact on hemodynamics, making it a useful sedative option for cesarean section.

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比较雷马唑仑和咪达唑仑在脊髓麻醉下剖宫产术中预防恶心和呕吐的效果:随机对照试验。
背景:预防术中恶心和呕吐(IONV)对脊髓麻醉下剖宫产术中产妇的安全至关重要。虽然咪达唑仑可预防 IONV,但我们假设雷咪唑仑因其对血流动力学的影响最小而更具优势。我们比较了两种药物对 IONV 的影响:方法:计划进行剖宫产的产妇被随机分配到接受咪达唑仑或瑞咪唑仑。她们分别服用 2 毫克咪达唑仑或 5 毫克雷咪唑仑,并根据要求追加剂量。主要结果指标是镇静过程中新出现 IONV 的发生率。其他结果包括总体 IONV、止吐药的使用、颤抖、血液动力学变量、镇静量表评分和满意度评分:结果:分析了 80 名参与者的数据。尽管两组的血液动力学趋势相当,但瑞美唑仑组诱导的镇静程度更深(PGroup × Time < 0.001)。两组的总体 IONV 发生率相当(咪达唑仑组 27.5% 对瑞咪唑仑组 17.5%,绝对风险降低 [ARR]:0.100,95% 置信区间):0.100,95% 置信区间 [CI] [-0.082, 0.282],P = 0.284);然而,镇静期间新出现的 IONV 在咪达唑仑组显著减少(20.0% vs. 5.0%,ARR:0.150,95% CI [0.009, 0.291],P = 0.043)。瑞马唑仑组的止吐药使用率也较低(15.0% vs. 2.5%,ARR:0.125,95% CI [0.004,0.246],P = 0.048):结论:与咪达唑仑相比,雷咪唑仑能明显降低新发IONV的发生率和严重程度,对血流动力学的影响极小,是剖宫产术中一种有效的镇静剂选择。
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来源期刊
CiteScore
6.20
自引率
6.90%
发文量
84
审稿时长
16 weeks
期刊最新文献
Response to "Comment on effects of remimazolam versus dexmedetomidine on recovery after transcatheter aortic valve replacement under monitored anesthesia care: a propensity score-matched, non-inferiority study". Response to "Comment on 'Effects of remimazolam versus dexmedetomidine on recovery after transcatheter aortic valve replacement under monitored anesthesia care: a propensity score-matched, non-inferiority study'". Anesthesiologic relevance of Klinefelter syndrome - discussion based on a case report. Comment on "Effects of remimazolam versus dexmedetomidine on recovery after transcatheter aortic valve replacement under monitored anesthesia care: a propensity score-matched, non-inferiority study". Comment on: "Effects of remimazolam versus dexmedetomidine on recovery after transcatheter aortic valve replacement under monitored anesthesia care: a propensity score-matched, non-inferiority study".
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