Clinical Application Of Remazolam In Neurosurgical Operation Under Neuroelectrophysiological Monitoring

Objective:To study the effect of Remazolam on intraoperative neurophysiological monitoring(IONM)and anesthesia effect in neurosurgery,and to explore whether Remazolam can be applied to neurosurgery under neurophysiological monitoring,so as to find a new anesthesia scheme for such anesthesia.Methods:Sixty patients undergoing elective subtentorial tumor resection,aged between 18and 65 years old,male and female,ASA grade I or II,body mass index(BMI)between18.5-23.9 kg/m~2,were randomly divided into remazolam group(group R)and propofol group(group P).Patients in group R and group P were given rapid intravenous induction,followed by sufentanil 0.3ug/kg,etomidate 0.1-0.4mg/kg,0.15mg/kg cis-atracurium.In group R,remifentanil 0.3-1.2 mg/kg/h,remifentanil 0.1-0.2ug/kg/min,cis-atracurium0.1mg/kg/h,inhalation of 0.5 MAC sevoflurane were used to maintain anesthesia.In group P,propofol 4-12mg/kg,remifentanil 0.1ug-0.2ug/kg/min,cis-atracurium 0.1mg/kg/h,inhalation of 0.5MAC sevoflurane were used to maintain anesthesia.Hemodynamic parameters and bispectral index(BIS)values were recorded at four time points:T0 when the patient was awake,T1 after administration of induction drugs,T2 immediately after intubation,T3 when the dural incistion,and T4 when the tumor was free.When the anesthesia entered the stable period,the amplitude and latency of N20 and P40 of somatosensory evoked potentials(SSEP)and motor evoked potentials(MEP)of the upper and lower limbs were recorded as the baseline values,and the amplitude and latency of SSEP and MEP of the upper and lower limbs during the free resection of the tumor were recorded.The total amount of remifentanil needed to maintain anesthesia during operation was compared between the two groups.The operation time,intraoperative blood loss,postoperative recovery and extubation time were compared between the two groups.Results:1.In terms of hemodynamics,MAP and HR in group P were significantly lower than those in group R at T3 and T4(P<0.05).hypotension and bradycardia in group R’s incidence was lower than that in group C(P<0.05).2.In the evoked potential,the control group and the experimental group can successfully monitor the evoked potential.In group P,SSEP amplitude decreased and latency prolonged compared with the baseline value(P<0.05).There was no significant difference in SSEP between group R and baseline.There was no significant difference in the baseline value of SSEP between group P and group R.The amplitude of SSEP in group P was lower than that in group R,and the latency was longer,the difference was statistically significant(P<0.05).There was no significant difference in the amplitude and latency of MEP between the two groups at each time point(P>0.05).3.Group R’s anesthetic dosage was significantly lower than that of group P(P<0.05)in terms of opioids.(P<0.05).4.In terms of postoperative recovery,the postoperative recovery time(eye opening)and extubation time in group P were significantly longer than those in group R(P<0.05).Conclusion:Remazolam can be successfully applied to neurosurgery requiring neurophysiological monitoring.It can not only improve the quality of evoked potentials,but also reduce the amount of remifentanil,maintain the stability of intraoperative hemodynamics,and reduce the occurrence of intraoperative adverse reactions.It is recommended to use remazolam in neurosurgery requiring neurophysiological monitoring.