Benzodiazepines
Conditions
Brief summary
Spinal cord injury is one of the most dangerous complications of scoliosis orthopedic surgery, and the Stagnara awakening test has been used in orthopedic spine surgery and is considered the gold standard for detecting spinal cord injury. During the awakening test, the patient is awakened from anesthesia and, in conjunction with a neurological assessment, moves his or her fingers and toes to determine the integrity of spinal cord motor function in order to avoid spinal cord injury. During this procedure, the patient still requires a degree of sedation and analgesia to tolerate tracheal intubation and surgical pain. Remazolam benzoate for injection is a new class of benzodiazepines that are ultra-short-acting sedative/anesthetic drugs. It has the advantages of rapid onset, rapid elimination, and no drug accumulation by continuous infusion, and has the advantage of being applied to wake up during spinal orthopedic surgery, but its effectiveness and safety are still unclear. This study aims to elucidate the safety and efficacy of rimazolam benzoate for injection for arousal in spinal orthopedic surgery through a single-center, randomized, single-blind, positive drug-controlled trial, with the aim of providing a basis for the development of a safe and effective anesthetic protocol for such surgery.
Interventions
DRUGRemimazolam
During induction of anesthesia, the rimazolam group was given rimazolam pumped at a rate of 12 mg/kg/h During the maintenance phase of anesthesia, the rimazolam group was given 1.0-2.0 mg/kg/h of rimazolam continuously pumped.
DRUGPropofol
During induction of anesthesia, propofol 2mg/kg was given, and during the maintenance phase of anesthesia, propofol 6-8mg/kg/h was given as a continuous pump.
Sponsors
Beijing Chao Yang Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
Criteria: Inclusion Criteria: 1. Age greater than 18 years and less than 60 years 2. Elective scoliosis orthopaedic surgery under general anesthesia. 3. ASA Physical Score I-III 4. Signed informed consent.
Exclusion criteria
1. Patients who cannot understand the method and requirements of the arousal test and cannot cooperate in completing the arousal test. 2. Patients with limb sensory-motor dysfunction. 3. Patients with a history of severe neurological disorders. 4. Patients with psychiatric disorders. 5. Patients who have taken benzodiazepines and/or opioids daily for one month or intermittently for the last three months. 6. Patients with concomitant severe respiratory and circulatory disorders, including acute heart failure, unstable angina, resting ECG heart rate \<50 beats/min, QTc: ≥ 470ms in men and ≥ 480ms in women, third-degree AV block, severe arrhythmia, moderate to severe heart valve disease, chronic obstructive pulmonary disease, and history of asthma. 7. Abnormal liver and kidney function: ALT and/or AST exceeding 2.5 times the upper limit of the medical reference range; urea or urea nitrogen ≥1.5 × ULN, blood creatinine greater than the upper limit of normal values.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mean time to arousal | Perioperative period | the time between the cessation of intraoperative drug infusion and the subject's ability to move the toes on command. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Quality of arousal | Perioperative period | Class I: the patient wakes up when called, is quiet and moves the limbs as instructed; Class II, the patient wakes up suddenly, moves the limbs involuntarily, does not endanger the internal fixation and tracheal tube, and can move the limbs as instructed; Class III, the patient wakes up suddenly, moves the trunk violently and requires pressure to not endanger the internal fixation and tracheal tube |
| Proportion of successful induction of anesthesia | Perioperative period | The criteria for successful induction of anesthesia were that both of the following two requirements were met: completion of tracheal intubation; and no use of remedial sedative drugs |
| Mean time from discontinuation at the end of surgery to full awakening of the subject | Perioperative period | time to the first of three consecutive MOAA/S scores of 5 |
| EEG characteristics during the induction, maintenance and awakening periods | Perioperative period | EEG power in alpha band, beta band, theta band, and gamma band |
| Mean time from initiation of dosing to MOAA/S score ≤1 | Perioperative period | Mean time from initiation of dosing to MOAA/S score ≤1 |
Other
| Measure | Time frame | Description |
|---|---|---|
| Other adverse events | Postoperative 28 days | Other adverse events within 28 days after surgery were noted |
Outcome results
None listed