Anesthetic Effects And Safety Of Remimazolam Combined With Alfentanil In Painless Hysteroscopic Surgery

Objective:To investigate the anesthetic effect and safety of remimazolam combined with alfentanil in painless hysteroscopic surgery.Methods:100 patients with hysteroscopy who were admitted to our hospital from May2022 to October 2022 were selected and divided into remimazolam combined with alfentanil group（RA group,n=50）and propofol combined with alfentanil group（PA group,n=50）by random number table method.Two groups of patients were given intravenous injection of opioid analgesic drug alfentanil 10 ug/kg before induction.After the beginning of anesthesia induction,patients in RA group were given intravenous infusion of remimazolam 6 mg·kg^-1·h^-1,and patients in PA group were given intravenous injection of propofol 1.5 mg/kg.The changes of heart rate（HR）,mean arterial pressure（MAP）,oxygen saturation（Sp O₂）and respiratory rate（RR）were recorded at the time points of entering the operating room（T₀）,modified observer’s assessment of alertness/sedation（MOAA/S）0（T₁）,cervical dilatation（T₂）,end of operation（T₃）and anesthesia recovery（T₄）.The anesthesia induction time,operation time and anesthesia recovery time of the two groups were recorded.The adverse reactions such as injection pain,respiratory depression,hypotension,hypoxemia,intraoperative body movement and cough were compared between the two groups.The visual analogue scale（VAS）of pain score and the incidence of postoperative nausea and vomiting（PONV）were recorded in the two groups at the 6h after operation.Results:Compared between groups,the HR,MAP and Sp O₂in RA group were significantly higher than those in PA group at T₁、T₂、T₃and T₄and the difference was statistically significant（P<0.05）.There was no significant difference in the RR between the two groups（P>0.05）.Intra-group comparison,RA group:Compared with HR,MAP and Sp O₂at T₀,the HR,MAP and Sp O₂at T₁and T₂decreased,and the difference was statistically significant（P<0.05）,there was no significant difference in RR at different time points in the group（P>0.05）.PA group:Compared with HR,MAP and Sp O₂at T₀,HR,MAP and Sp O₂at T₁、T₂、T₃and T₄decreased,and the difference was statistically significant（P<0.05）.There was no significant difference in RR at different time points within the group（P>0.05）.The anesthesia induction time in RA group was significantly longer than that in PA group,and the anesthesia recovery time was significantly shorter than that in PA group with statistical significance（P<0.05）,while there was no statistical significance in the operation time between the two groups（P>0.05）.The incidence of injection pain,respiratory depression,hypotension and hypoxemia in RA group were significantly lower than those in PA group,and the difference was statistically significant（P<0.05）.There was no significant difference in the incidence of intraoperative body movement and cough between RA group and PA group（P>0.05）.There was no significant difference in VAS score,PONV incidence between RA group and PA group after operation（P>0.05）.Conclusion:Based on the use of the same dose of alfentanil,remimazolam can provide similar anesthetic effects to propofol in painless hysteroscopic diagnosis and treatment,and it also has stable hemodynamics,low incidence of hypoxemia,rapid postoperative recovery,fewer complications and other characteristics,with reliable safety,can be applied in clinical promotion.