Effects Of Remazolam Besylate On The Quality Of Recovery From Anesthesia And Cognitive Function In Patients Undergoing Hysteroscopic Surgery

Object:Postoperative cognitive dysfunction is one of the important factors affecting the prognosis of patients,but there are few targeted studies.Hysteroscopy enables direct visualization of the uterine cavity through a uterine endoscope,pathological specimens can be sampled for suspicious lesions and realize “seeing and curing”treatment,like endometrial polyps or other diseases.Hysteroscopy has become a widely accepted method of diagnosis and treatment of gynecological diseases.Intraoperative anesthesia can reduce the incidence of major adverse reactions such as pain and vasovagal reaction during hysteroscopic surgery.Hysteroscopic anesthesia is mainly used Propofol,but the incidence of cardiopulmonary adverse reactions is high.Remazolam as a new type of benzodiazepine,has been proven to be no less effective than propofol in a variety of endoscopic anesthesia,have lower incidence of adverse reactions.Until now,there are few studies on the application of remazolam in hysteroscopy.And there are few studies on the effect of postoperative cognitive function.In order to further verify its sedative effect and safety in this operation,and to evaluate its impact on postoperative cognitive function.We designed this targeted study.Methods:This study is a prospective,randomized,single-blind,controlled experiment.Select 112 patients undergoing hysteroscopic surgery in Qingdao Women and Children’s Hospital.The patients were included in the experimental group and the control group,according to two principles,random and 1:1 ratio,and each group included 56 patients.Make pre-operative preparations according to the requirements of hysteroscopy.The anesthesia schemes of the two groups are respectively,the experimental group: remazolam besylate combined with remifentanil,anesthesia induction and intraoperative maintenance,the induction dose of the two drugs are 0.4mg/kg and 1μg/kg,and the maintenance dose is 1mg /(Kg·h)and 0.2～0.3μg/(kg·min).Control group:Propofol combined with remifentanil,respectively 2mg/kg、1μg/kg and 4mg/(kg·h)、0.2～0.3μg/(kg·min),to induce and maintain.During the operation,the drug dose is adjusted according to the BIS value,if the anesthesia is too shallow,add propofol0.25mg/kg or remazolam besylate 0.2mg/kg;if the anesthesia is too deep,reduce the original dose by 10%,maintain the BIS value between 40 and 60.The drug was discontinued after the operation.The hemodynamic indicators(HR,MAP,Sp O2)of 5 time nodes were monitored,which were preoperative,befer inserting laryngeal mask,10 min after LMA insertion,at the end of the operation,and 10 min after pulling out the LMA,and marked as T0,T1,T2,T3,T4.Record the time indicators of the two groups of patients,including the induction of anesthesia,the operation time,how long after the operation to breathe,how long after the operation to recover the orientation,how long after removing of the LMA,and how long after the operation is to open the eyes.Record the dosage of remifentanil in the two groups.Record the scores of the two groups of three indicators,VAS、OAAS and MMSE.Record the adverse reactions in the two groups,and calculate the incidence and total incidence.Results:All 112 patients completed the study.There was no significant difference in non-research indicators between the two groups of patients(P>0.05).The heart rate(HR)and blood oxygen saturation(Sp O2)in experimental groups at T3 and T4 were significantly lower than those in control group(F=2.240～4.917,P<0.05).The anesthesia induction time,dosage of remifentanil,postoperative breathing recovery time,the LMA removal time,eye-opening time and the orientation recovery time in experimental group were significantly shorter or lower than those in control group(t=-11.581--4.139,P< 0.05).The Visual Analogue Scale scores of experimental group were significantly lower than those of control group at 6 h and 24 h after surgery(F=4.316、2.130,P<0.05).The scores of Observer’s Assessment of Alertness/Sedation and Mini-Mental State Examination were significantly higher in experimental group than those in control group at 3,6 and 24 h after surgery(F = 2.132 ～5.065,P < 0.05).There was no significant difference in the total incidence rate of perioperative adverse events between the two groups(P>0.05).Conclusion:In painless hysteroscopy,remimazolam besylate combined with remifentanil for anesthesia induction can effectively analgesia and sedation and improve the quality of anesthesia recovery,with fast postoperative cognitive function and few adverse reactions.Therefore it is worth recommending.