Comparison of Remimazolam and Propofol for Intravenous Anesthesia on Trigeminocardiac Reflex in Percutaneous Balloon Compression for Trigeminal Neuralgia: A Randomized Controlled Trial.

IF 4.7 2区医学 Q1 CHEMISTRY, MEDICINAL Drug Design, Development and Therapy Pub Date : 2024-11-15 eCollection Date: 2024-01-01 DOI:10.2147/DDDT.S473700

DongJu Long, Kai Chen, YaXi Li, PeiYao He, XinNing Li, XiuNan Qin, YaPing Wang, YanYing Xiao

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Abstract

Background: Trigeminal neuralgia usually presents as incapacitating facial pain. Percutaneous balloon compression (PBC) is frequently utilized to manage this ailment. Trigeminocardiac reflex (TCR) commonly presents with sudden severe bradycardia or even asystole, alongside a sudden increase in blood pressure during this surgical procedure. Notably, remimazolam has been reported to maintain higher heart rate (HR) levels during anesthesia than propofol. Thus, this study aims to assess the impact of remimazolam anesthesia versus propofol on TCR occurrence during this procedure.

Methods: This randomized controlled trial involved patients with trigeminal neuralgia scheduled for elective PBC. Patients were randomly assigned to receive either remimazolam or propofol for anesthesia. The primary outcome was the incidence of TCR, a potential complication during the procedure. Secondary outcomes included the occurrence of severe TCR, usage of atropine, HR at the time of foramen ovale puncture (T4), HR at the time of trigeminal ganglion compression (T5), and any adverse events.

Results: A total of 80 patients were included in the study, with 40 patients in each group. The incidence of TCR was significantly lower in the remimazolam group compared to the propofol group (30.0% vs 82.5%; risk difference -52.5%, 95% CI -67.3% to -18.6%; P < 0.001). The remimazolam group also showed a lower incidence of severe TCR (7.5% vs 45.0%) and significantly lower usage of atropine compared to the propofol group (P < 0.001). Furthermore, HR at T4 and T5 were higher in the remimazolam than in the propofol group (P < 0.001). There was no significant difference in the incidence of adverse events between the two groups.

Conclusion: In PBC surgery for trigeminal neuralgia, remimazolam-based intravenous anesthesia showed a higher HR and a lower incidence of TCR than propofol without any increased adverse events.

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经皮球囊压迫治疗三叉神经痛中瑞马唑仑和异丙酚静脉麻醉对三叉神经反射的影响比较：随机对照试验。

背景：三叉神经痛通常表现为令人丧失能力的面部疼痛。经皮球囊压迫术（PBC）常用于治疗这种疾病。三叉神经心反射（TCR）通常会在手术过程中突然出现严重心动过缓甚至心跳停止，同时血压也会突然升高。值得注意的是，与异丙酚相比，瑞马唑仑在麻醉期间能维持更高的心率（HR）水平。因此，本研究旨在评估雷马唑仑麻醉与异丙酚麻醉对该手术过程中 TCR 发生的影响：这项随机对照试验涉及计划进行择期 PBC 的三叉神经痛患者。患者被随机分配接受雷马唑仑或异丙酚麻醉。主要结果是手术过程中可能出现的并发症 TCR 的发生率。次要结果包括严重TCR的发生率、阿托品的使用率、卵圆孔穿刺（T4）时的心率、三叉神经节压迫（T5）时的心率以及任何不良事件：研究共纳入 80 名患者，每组 40 人。与异丙酚组相比，雷马唑仑组的TCR发生率明显较低（30.0% vs 82.5%；风险差异-52.5%，95% CI -67.3% to -18.6%；P < 0.001）。与异丙酚组相比，雷马唑仑组的严重TCR发生率也更低（7.5% vs 45.0%），阿托品用量也显著降低（P < 0.001）。此外，与异丙酚组相比，瑞马唑仑组 T4 和 T5 的 HR 更高（P < 0.001）。两组的不良反应发生率无明显差异：结论：在三叉神经痛的PBC手术中，与异丙酚相比，基于雷马唑仑的静脉麻醉显示出更高的HR和更低的TCR发生率，而不良反应却没有增加。

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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.