Seizure after flumazenil reversal for total intravenous anaesthesia with remimazolam versus propofol: a matched retrospective cohort analysis of a large Japanese nationwide inpatient database

IF 9.2 1区医学 Q1 ANESTHESIOLOGY British journal of anaesthesia Pub Date : 2025-02-06 DOI:10.1016/j.bja.2024.11.046

Shuichiro Komatsu , Toshiaki Isogai , Kanako Makito , Hiroki Matsui , Kiyohide Fushimi , Hideo Yasunaga

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Abstract

Background

Remimazolam is a novel anaesthetic and sedative agent that offers several advantages, including minimal adverse haemodynamic effects and availability of a specific antidote, flumazenil. Flumazenil can induce seizures as an adverse effect; however, the incidence of seizures after flumazenil reversal after total intravenous anaesthesia with remimazolam (remimazolam-flumazenil) remains unknown. We compared the risk of seizures between total i.v. anaesthesia with remimazolam-flumazenil or propofol.

Methods

We retrospectively identified patients who underwent elective surgery (excluding brain surgery) with total i.v. anaesthesia in Japan between April 2020 and March 2022 using the Japanese Diagnosis Procedure Combination database. Patients were divided into remimazolam-flumazenil and propofol groups. Patients in the remimazolam-flumazenil group were matched to those in the propofol group at a variable ratio of 1:3 (maximum) based on age, sex, hospital, and type of surgery. We conducted conditional logistic regression analyses to assess the association between total i.v. anaesthesia with remimazolam-flumazenil and the incidence of perioperative seizures.

Results

We identified 12 033 patients who underwent total i.v. anaesthesia with remimazolam-flumazenil and 432 275 patients with propofol, creating a matched cohort of 19 105. The crude incidence of seizures was 0.66% (95% confidence interval, 0.63–0.68%). There was no significant difference in seizures between the two groups (adjusted odds ratio, 1.08; 95% confidence interval, 0.49–2.37).

Conclusions

We observed no significant differences in perioperative seizures between remimazolam-flumazenil and propofol in patients undergoing non-neurological surgery. This suggests that remimazolam-flumazenil is a possible alternative to total i.v. anaesthesia with propofol.

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氟马西尼逆转用雷马唑仑与异丙酚进行全静脉麻醉后癫痫发作：一项对日本全国大型住院患者数据库的匹配回顾性队列分析

背景：Remimazolam是一种新型的麻醉和镇静药物，具有以下几个优点，包括最小的不良血流动力学影响和特异性解毒剂氟马西尼的可用性。氟马西尼可诱发癫痫发作；然而，用雷马唑仑（雷马唑仑-氟马西尼）全静脉麻醉后氟马西尼逆转后癫痫发作的发生率仍然未知。我们比较了全静脉麻醉与雷马唑仑-氟马西尼或异丙酚之间癫痫发作的风险。方法：我们使用日本诊断程序组合数据库对2020年4月至2022年3月期间在日本接受选择性手术（不包括脑外科手术）全静脉麻醉的患者进行回顾性研究。患者分为雷马唑仑-氟马西尼组和异丙酚组。雷马唑仑-氟马西尼组患者与异丙酚组患者根据年龄、性别、医院和手术类型以1:3（最大）的可变比例进行匹配。我们进行了条件logistic回归分析，以评估雷马唑仑-氟马西尼全静脉麻醉与围手术期癫痫发作发生率之间的关系。结果：我们确定了12033例接受雷马唑仑-氟马西尼全静脉麻醉的患者和432 275例异丙酚患者，创建了一个匹配的19105例队列。癫痫发作的粗发生率为0.66%（95%可信区间为0.63-0.68%）。两组患者癫痫发作无显著差异(校正优势比为1.08；95%置信区间为0.49-2.37)。结论：我们观察到雷马唑仑-氟马西尼和异丙酚在非神经外科手术患者围手术期癫痫发作方面无显著差异。这表明雷马唑仑-氟马西尼是异丙酚全静脉麻醉的可能替代方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

British journal of anaesthesia 医学-麻醉学

CiteScore

13.50

自引率

7.10%

发文量

488

审稿时长

27 days

期刊介绍： The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience. The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence. Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.