| Objective: Percutaneous microballoon compression of trigeminal nerve is a minimally invasive surgical method for the treatment of trigeminal neuralgia in recent years.However,the severe hemodynamic fluctuations caused by the trigeminal cardiac reflex during compression are potentially harmful to patients.The purpose of this study was to investigate the effect of remimazolam general anesthesia on hemodynamics during the operation.It is divided into two parts.The first part discusses the effect of remimazolam general anesthesia on hemodynamics,recovery and changes in the expression of stress response and inflammatory factors in the blood compared with propofol.The second part investigates the effects of remimazolam anesthesia at a deeper anesthesia depth(BIS value below 40)and traditional anesthesia depth(BIS value 40-60)on hemodynamic stability,recovery,stress response and inflammatory factors during balloon compression.Method:Part Ⅰ: From March 2021 to June 2021,40 patients with trigeminal neuralgia who underwent percutaneous microballoon trigeminal ganglion compression in the pain department of the Second Xiangya Hospital of Central South University were selected.According to digital random method,they were divided into remimazolam anesthesia(group R)group and propofol anesthesia(group P)group.Remimazolam was used to induce and maintain general anesthesia in R group,and propofol was used to induce and maintain in P group.The BIS value was maintained at40-60 in both groups.Before anesthesia,the puncture needle entered the foramen ovale,immediately after the balloon was compressed,immediately after the compression was released,and 1 min after the compression was released.The heart rate,mean arterial pressure,the number of adverse events of heart rate and blood pressure in each group,and the dose of vasoactive drugs were recorded.At the same time,the recovery time from anesthesia,plasma catecholamines(epinephrine,norepinephrine,dopamine),serum inflammatory factors(interleukin-6,tumor necrosis facto-α,high-sensitivity C-reactive protein)were recorded.Part Ⅱ: From June 2021 to March 2022,60 patients with trigeminal neuralgia who underwent percutaneous microballoon trigeminal ganglion compression in the pain department of the Second Xiangya Hospital of Central South University were selected.The patients were divided into remimazolam deep anesthesia(RD)group,remimazolam conventional anesthesia(RT)group,and propofol deep anesthesia(PD)group according to the digital random method.The RD group used remimazolam for anesthesia induction and maintenance,and the intraoperative BIS value was less than 40;the RT group used remimazolam for anesthesia induction and maintenance,and the intraoperative BIS was maintained at 40-60;the PD group used propofol for Anesthesia induction and maintenance,intraoperative maintenance BIS less than 40.Before anesthesia,the puncture needle entered the foramen ovale,immediately after the balloon was compressed,immediately after the compression was released,and 1 min after the compression was released.The heart rate,mean arterial pressure,the number of adverse events of heart rate and blood pressure in each group,and the dose of vasoactive drugs were recorded.At the same time,the recovery time from anesthesia,plasma catecholamines(epinephrine,norepinephrine,dopamine),serum inflammatory factors(interleukin-6,tumor necrosis facto-α,high-sensitivity C-reactive protein)were recorded.Result:Part Ⅰ:(1)Hemodynamics: 1)Heart rate: when the puncture needle entered the foramen ovale(T1),compared with the baseline(T0),heart rate decreased in both groups of patients.Compared with the P group,the heart rate of the R group was significantly increased(P<0.05).Compared with the difference between TI and T0,the heart rate in the R group was less than that in the P group(P<0.05).2)Mean arterial pressure: At the moment of balloon compression of the foramen ovale(T2),the blood pressure in the P group was significantly higher than the baseline value,but there was no significant difference in the mean arterial pressure at different times during the operation between the two groups(P>0.05).3)Use of vasoactive drugs: There was no significant difference between the two groups of patients(P>0.05).(2)Wake-up situation: Compared with the P group,the R group had a shorter recovery time,and the difference was statistically significant(P<0.05).(3)Stress and inflammatory factors:There was no significant difference in catecholamines(epinephrine,norepinephrine,dopamine)and serum inflammatory factors(interleukin-6,tumor necrosis factor-α,high-sensitivity C-reactive protein)between the two groups(P>0.05).Part Ⅱ:(1)Hemodynamics: 1)Heart rate: When the puncture needle entered the foramen ovale(T1),compared with the baseline(T0),the heart rate of patients in the RD group and PD group decreased significantly(P<0.05);There was no significant difference in the heart rate at T1 and the heart rate reduction when compared to T0 between the RD group and the RT group(P>0.05).But the heart rate of the RT group was higher than that of the RD group when the balloon compressed the foramen ovale and relieved the compression(P<0.05).There was no significant difference in heart rate at different times between PD group and RD group,and the difference in heart rate at different times compared with T0(P>0.05).2)Mean arterial pressure: During balloon compression(T2),compared with baseline(T0),the mean arterial pressure of the three groups of patients showed a significant increase(P<0.05);However,the mean arterial pressure at different times during the operation and the increase in mean arterial pressure when compared with T0 were not significantly different among the three groups(P>0.05).3)Use of vasoactive drugs: the dose of atropine used in the RD group was lower than that in the PD group,and the difference was statistically significant(P<0.05);there was no statistical difference in the use of other vasoactive drugs(P>0.05).(2)Wake-up situation: Compared with RT group,the recovery time of RD group was longer,and the difference was statistically significant(P<0.05).There was no significant difference in wake-up time between the RD group and the PD group(P>0.05).(3)Stress and inflammatory factors: There was no significant difference in catecholamines(epinephrine,norepinephrine,dopamine)and serum inflammatory factors(interleukin-6,tumor necrosis factor-α,high-sensitivity C-reactive protein)among the groups of patients(P>0.05).Conclusion:Part Ⅰ: Remimazolam is used for the induction and maintenance of anesthesia in PMC surgery,which can achieve the depth of sedation required for anesthesia.When the puncture needle was passed to the foramen ovale,the heart rate decreased less in the remimazolam group than in the propofol group,which could alleviate the severe heart rate slowing reaction during PMC surgery.At the same time,remimazolam is faster than propofol anesthesia.However,it had no significant effect on the release of catecholamines and inflammatory factors in the short term during the operation.Part Ⅱ: Remimazolam deep anesthesia for the induction and maintenance of anesthesia in PMC surgery will weaken its protective effect of maintaining a faster heart rate.At the same time,the recovery from deep anesthesia with remimazolam is slower than that of conventional anesthesia with remimazolam.The depth of anesthesia for remimazolam had no significant effect on the release of catecholamines and inflammatory factors in the short term during the operation. |
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