Ji-Hyeon Kim, Jae-Sik Nam, Wan-Woo Seo, Kyung-Woon Joung, Ji-Hyun Chin, Wook-Jong Kim, Dae-Kee Choi, In-Cheol Choi
{"title":"经导管主动脉瓣置换术后在监测麻醉护理下使用雷马唑仑与右美托咪定对恢复的影响:倾向得分匹配、非劣效性研究。","authors":"Ji-Hyeon Kim, Jae-Sik Nam, Wan-Woo Seo, Kyung-Woon Joung, Ji-Hyun Chin, Wook-Jong Kim, Dae-Kee Choi, In-Cheol Choi","doi":"10.4097/kja.24138","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Minimalist transcatheter aortic valve replacement (TAVR) under monitored anesthesia care (MAC) emphasizes early recovery. Remimazolam is a novel benzodiazepine with a short recovery time. This study hypothesized that remimazolam is non-inferior to dexmedetomidine in terms of recovery after TAVR.</p><p><strong>Methods: </strong>In this retrospective observational study, remimazolam was compared to dexmedetomidine in patients who underwent TAVR under MAC at a tertiary academic hospital between July 2020 and July 2022. The primary outcome was timely recovery after TAVR, defined as discharge from the intensive care unit within the first day following the procedure. Propensity score matching was used to compare timely recovery between remimazolam and dexmedetomidine, applying a non-inferiority margin of -10%.</p><p><strong>Results: </strong>The study included 464 patients, of whom 218 received remimazolam and 246 received dexmedetomidine. After propensity score matching, 164 patients in each group were included in the analysis. Regarding timely recovery after TAVR, remimazolam was non-inferior to dexmedetomidine (152 of 164 [92.7%] in the remimazolam group versus 153 of 164 [93.3%] in the dexmedetomidine group, risk difference [95% CI]: -0.6% [-6.7%, 5.5%]). The use of remimazolam was associated with fewer postoperative vasopressors/inotropes (21 of 164 [12.8%] vs. 39 of 164 [23.8%]) and temporary pacemakers (TPMs) (76 of 164 [46.3%] vs. 108 of 164 [65.9%]) compared to dexmedetomidine.</p><p><strong>Conclusions: </strong>In patients undergoing TAVR under MAC, remimazolam was non-inferior to dexmedetomidine in terms of timely recovery. Remimazolam may be associated with better postoperative recovery profiles, including a lesser need for vasopressors/inotropes and TPMs.</p>","PeriodicalId":17855,"journal":{"name":"Korean Journal of Anesthesiology","volume":" ","pages":"537-545"},"PeriodicalIF":4.2000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467503/pdf/","citationCount":"0","resultStr":"{\"title\":\"Effects of remimazolam versus dexmedetomidine on recovery after transcatheter aortic valve replacement under monitored anesthesia care: a propensity score-matched, non-inferiority study.\",\"authors\":\"Ji-Hyeon Kim, Jae-Sik Nam, Wan-Woo Seo, Kyung-Woon Joung, Ji-Hyun Chin, Wook-Jong Kim, Dae-Kee Choi, In-Cheol Choi\",\"doi\":\"10.4097/kja.24138\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Minimalist transcatheter aortic valve replacement (TAVR) under monitored anesthesia care (MAC) emphasizes early recovery. Remimazolam is a novel benzodiazepine with a short recovery time. This study hypothesized that remimazolam is non-inferior to dexmedetomidine in terms of recovery after TAVR.</p><p><strong>Methods: </strong>In this retrospective observational study, remimazolam was compared to dexmedetomidine in patients who underwent TAVR under MAC at a tertiary academic hospital between July 2020 and July 2022. The primary outcome was timely recovery after TAVR, defined as discharge from the intensive care unit within the first day following the procedure. Propensity score matching was used to compare timely recovery between remimazolam and dexmedetomidine, applying a non-inferiority margin of -10%.</p><p><strong>Results: </strong>The study included 464 patients, of whom 218 received remimazolam and 246 received dexmedetomidine. After propensity score matching, 164 patients in each group were included in the analysis. Regarding timely recovery after TAVR, remimazolam was non-inferior to dexmedetomidine (152 of 164 [92.7%] in the remimazolam group versus 153 of 164 [93.3%] in the dexmedetomidine group, risk difference [95% CI]: -0.6% [-6.7%, 5.5%]). The use of remimazolam was associated with fewer postoperative vasopressors/inotropes (21 of 164 [12.8%] vs. 39 of 164 [23.8%]) and temporary pacemakers (TPMs) (76 of 164 [46.3%] vs. 108 of 164 [65.9%]) compared to dexmedetomidine.</p><p><strong>Conclusions: </strong>In patients undergoing TAVR under MAC, remimazolam was non-inferior to dexmedetomidine in terms of timely recovery. Remimazolam may be associated with better postoperative recovery profiles, including a lesser need for vasopressors/inotropes and TPMs.</p>\",\"PeriodicalId\":17855,\"journal\":{\"name\":\"Korean Journal of Anesthesiology\",\"volume\":\" \",\"pages\":\"537-545\"},\"PeriodicalIF\":4.2000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11467503/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Korean Journal of Anesthesiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.4097/kja.24138\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/23 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Korean Journal of Anesthesiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4097/kja.24138","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/23 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:在监测麻醉护理(MAC)下进行经导管主动脉瓣置换术(TAVR)强调早期恢复。雷马唑仑是一种新型苯二氮卓类药物,恢复时间短。本研究假设,就TAVR术后恢复而言,雷马唑仑不劣于右美托咪定:在这项回顾性观察研究中,对 2020 年 7 月至 2022 年 7 月期间在一家三级学术医院接受 MAC 下 TAVR 的患者进行了雷马唑仑与右美托咪定的比较。主要研究结果是 TAVR 术后的及时康复,即术后第一天内从重症监护室出院。采用倾向得分匹配法比较雷马唑仑和右美托咪定的及时恢复情况,非劣效性差值为-10%:研究共纳入 464 名患者,其中 218 人接受了雷马唑仑治疗,246 人接受了右美托咪定治疗。经过倾向评分匹配后,每组各有164名患者纳入分析。在TAVR术后及时恢复方面,雷马唑仑的效果不劣于右美托咪定(雷马唑仑组164例中有152例[92.7%],右美托咪定组164例中有153例[93.3%],风险差异[95% CI]:-0.6% [-6.7% to 5.5%])。与右美托咪定相比,使用瑞马唑仑可减少术后使用血管加压剂/肌注(164例中的21例[12.8%]对164例中的39例[23.8%])和临时起搏器(TPM)(164例中的76例[46.3%]对164例中的108例[65.9%]):结论:对于在 MAC 下接受 TAVR 的患者,就及时恢复而言,雷马唑仑不优于右美托咪定。雷马唑仑可能与更好的术后恢复情况有关,包括对血管抑制剂/肌注和TPM的需求较少。
Effects of remimazolam versus dexmedetomidine on recovery after transcatheter aortic valve replacement under monitored anesthesia care: a propensity score-matched, non-inferiority study.
Background: Minimalist transcatheter aortic valve replacement (TAVR) under monitored anesthesia care (MAC) emphasizes early recovery. Remimazolam is a novel benzodiazepine with a short recovery time. This study hypothesized that remimazolam is non-inferior to dexmedetomidine in terms of recovery after TAVR.
Methods: In this retrospective observational study, remimazolam was compared to dexmedetomidine in patients who underwent TAVR under MAC at a tertiary academic hospital between July 2020 and July 2022. The primary outcome was timely recovery after TAVR, defined as discharge from the intensive care unit within the first day following the procedure. Propensity score matching was used to compare timely recovery between remimazolam and dexmedetomidine, applying a non-inferiority margin of -10%.
Results: The study included 464 patients, of whom 218 received remimazolam and 246 received dexmedetomidine. After propensity score matching, 164 patients in each group were included in the analysis. Regarding timely recovery after TAVR, remimazolam was non-inferior to dexmedetomidine (152 of 164 [92.7%] in the remimazolam group versus 153 of 164 [93.3%] in the dexmedetomidine group, risk difference [95% CI]: -0.6% [-6.7%, 5.5%]). The use of remimazolam was associated with fewer postoperative vasopressors/inotropes (21 of 164 [12.8%] vs. 39 of 164 [23.8%]) and temporary pacemakers (TPMs) (76 of 164 [46.3%] vs. 108 of 164 [65.9%]) compared to dexmedetomidine.
Conclusions: In patients undergoing TAVR under MAC, remimazolam was non-inferior to dexmedetomidine in terms of timely recovery. Remimazolam may be associated with better postoperative recovery profiles, including a lesser need for vasopressors/inotropes and TPMs.