Effect of Remimazolam- Vs Propofol-Based Intravenous Anesthesia on Surgical Stress Response and Post-Operative Immune Function in Patients with Gastric Radical Surgery.

IF 4.7 2区医学 Q1 CHEMISTRY, MEDICINAL Drug Design, Development and Therapy Pub Date : 2024-11-13 eCollection Date: 2024-01-01 DOI:10.2147/DDDT.S489167

Qingqing Xu, Xue Cheng, Hong Sun, Guangyuan Su, Yuanhui Fei, Chunhui Wang, Chao Han

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Abstract

Purpose: This study aimed to compare the impact of remimazolam-based versus propofol-based intravenous anesthesia on surgical stress and post-operative immune function in patients undergoing gastric radical surgery.

Patients and methods: Sixty-eight patients aged 50 to 80 undergoing gastric radical surgery were randomly assigned to the remimazolam group (group R) or the propofol group (group P), receiving remimazolam or propofol-based intravenous anesthesia, respectively. The primary outcome measured was peri-operative serum stress indicators and lymphocyte subtypes. Secondary outcomes included hemodynamic vitals, recovery quality, postoperative pain profiles and potential adverse effects.

Results: The demographic and surgical characteristics of the 60 analyzed patients were comparable. The absolute counts of CD3+CD4+ and CD3+CD8+ cell decreased significantly on POD1 compared with baseline. On POD3, the numbers of CD3+CD4+ cells in group R were lower than baseline and Group P, whereas the CD3+CD8+ cell counts in both groups were lower than baseline, with group R higher than group P. The CD3-CD16+CD56+ cell numbers in both groups on POD1 and POD3 decreased significantly compared to baseline with group P lower than group R on POD3. The serum levels of IL-1β, IL-6, TNF-α, ACTH and COR rose sharply 2 hours after the beginning of surgery compared to baseline. Notably, all these parameters in group R were higher than those in group P. Additionally, blood pressure and intra-operative vasoactive drug frequency in group R were higher than that in group P. No significant differences in recovery quality, postoperative pain profiles, and potential adverse effects were observed.

Conclusion: Remimazolam-based intravenous anesthesia might favour the recovery of cellular immune function in early postoperative period compared to propofol. On the contrary, remimazolam was inferior to propofol in suppressing surgical stress. Further studies with larger sample sizes are needed to confirm our findings.

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雷马唑仑与丙泊酚静脉麻醉对胃癌根治术患者手术应激反应和术后免疫功能的影响

目的：本研究旨在比较基于雷马唑仑和基于异丙酚的静脉麻醉对胃根治术患者手术应激和术后免疫功能的影响：68名年龄在50至80岁之间的胃根治术患者被随机分配到瑞马唑仑组（R组）或异丙酚组（P组），分别接受瑞马唑仑或异丙酚静脉麻醉。测量的主要结果是围手术期血清应激指标和淋巴细胞亚型。次要结果包括血液动力学生命体征、恢复质量、术后疼痛情况和潜在不良反应：结果：60 名接受分析的患者的人口统计学特征和手术特征具有可比性。与基线相比，CD3+CD4+ 和 CD3+CD8+ 细胞的绝对计数在 POD1 显著下降。在 POD3，R 组的 CD3+CD4+ 细胞数量低于基线和 P 组，而两组的 CD3+CD8+ 细胞数量均低于基线，R 组高于 P 组。两组的 CD3-CD16+CD56+ 细胞数量在 POD1 和 POD3 均较基线显著下降，P 组在 POD3 低于 R 组。手术开始 2 小时后，血清中 IL-1β、IL-6、TNF-α、ACTH 和 COR 水平与基线相比急剧上升。值得注意的是，R 组的所有这些参数都高于 P 组。此外，R 组的血压和术中血管活性药物使用频率也高于 P 组：结论：与异丙酚相比，基于雷马唑仑的静脉麻醉可能有利于术后早期细胞免疫功能的恢复。相反，雷马唑仑在抑制手术应激方面不如异丙酚。要证实我们的研究结果，还需要更多样本量的进一步研究。

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来源期刊

Drug Design, Development and Therapy CHEMISTRY, MEDICINAL-PHARMACOLOGY & PHARMACY

CiteScore

9.00

自引率

0.00%

发文量

382

审稿时长

>12 weeks

期刊介绍： Drug Design, Development and Therapy is an international, peer-reviewed, open access journal that spans the spectrum of drug design, discovery and development through to clinical applications. The journal is characterized by the rapid reporting of high-quality original research, reviews, expert opinions, commentary and clinical studies in all therapeutic areas. Specific topics covered by the journal include: Drug target identification and validation Phenotypic screening and target deconvolution Biochemical analyses of drug targets and their pathways New methods or relevant applications in molecular/drug design and computer-aided drug discovery* Design, synthesis, and biological evaluation of novel biologically active compounds (including diagnostics or chemical probes) Structural or molecular biological studies elucidating molecular recognition processes Fragment-based drug discovery Pharmaceutical/red biotechnology Isolation, structural characterization, (bio)synthesis, bioengineering and pharmacological evaluation of natural products** Distribution, pharmacokinetics and metabolic transformations of drugs or biologically active compounds in drug development Drug delivery and formulation (design and characterization of dosage forms, release mechanisms and in vivo testing) Preclinical development studies Translational animal models Mechanisms of action and signalling pathways Toxicology Gene therapy, cell therapy and immunotherapy Personalized medicine and pharmacogenomics Clinical drug evaluation Patient safety and sustained use of medicines.