Abstract：Objective To investigate the anesthetic effect of low-dose esketamine combined with remimazolam in patients during rotator cuff repair and its influence on related indexes. Methods Eighty patients who underwent arthroscopic rotator cuff repair in the Second Hospital of Shanxi Medical University from July 2022 to July 2023 were enrolled and were divided into observation group and control group according to random number table method, with 40 cases in each group. Anesthesia induction of patients in the observation group was taken by sufentanil, rocuronium bromide, etomidate and a low-dose esketamine, while the maintenance was conducted by remimazolam and remifentanil; anesthesia induction of patients in the control group was taken by sufentanil, rocuronium bromide, etomidate, while the maintenance was conducted by propofol and remifentanil. Hemodynamic parameters, awakening time, recovery time of spontaneous respiration, Ricker sedation-restlessness score, VAS score at 6 and 12 h after surgery, stress response indexes, and anesthesia-related adverse reactions were observed in the two groups. Results After anesthesia, systolic blood pressure (112.75±12.59)mmHg, diastolic blood pressure (70.87±6.95) mmHg and heart rate (71.45±7.63) beats/min of patients in the observation group were higher than those of the control group which were (98.37±12.77)mmHg, (65.57±7.46)mmHg and (71.35±6.38)beats/min respectively, and the differences were statistically significant (P<0.05). The time of awakening (4.63±4.72)min and recovery of spontaneous respiration (5.39±0.92) min in the observation group was shorter than the time of awakening (5.29±0.44) min and recovery of spontaneous respiration (8.23±1.34) min in the control group. Ricker sedation-restlessness score and the VAS score of the postoperative period of 6h were lower than those of the control group (P<0.05). the postoperative values of cortisol, epinephrine, ACTH and malondialdehyde in observation group were lower than those in the control group, the postoperative superoxide dismutase were higher than those in the control group, and the incidence of postoperative adverse reactions was lower than that in the control group, with statistical significance (P< 0.05). Conclusions The use of low-dose esketamine combined with remimazolam for anesthesia maintenance in rotator cuff repair can maintain hemodynamic stability, improve the quality of awakening, reduce the stress response, and reduce the incidence of anesthesia-related adverse reactions.
Song X,Wang F,Dong R,et al.Efficacy and safety of remimazolamtosilate combined with esketamine for analgesic sedation in mechanically ventilated icu patients: a single-arm clinical study protocol[J].Front Med,2022, 9:832105.
[4]
Zhang K,Bao Y,Han X,et al.Effects of opioid-free propofol or remimazolam balanced anesthesia on hypoxemia incidence in patients with obesity during gastrointestinal endoscopy: a prospective,randomized clinical trial[J]. Front Med,2023,10:1124743.
[5]
Lu C,Ren J,Guo X,et al. Effects of remimazolam combined with esketamine anesthesia on circulatory and respiratory function during painless gastroenteroscopy[J].Contrast Media Mol I,2022,12:1079099.
[6]
Wang X,Lin C,Lan L,et al. Perioperative intravenous S-ketamine for acute postoperative pain in adults: a systematic review and meta-analysis[J]. Clin Anesth,2021,75:110071.
[7]
Kim K M.Remimazolam: pharmacological characteristics and clinical applications in anesthesiology[J]. Anesth Pain Med,2022,17(1):1-11.
[8]
Chae D,Kim H C,Song Y,et al.Pharmacodynamic analysis of intravenous bolus remimazolam for loss of consciousness in patients undergoing general anaesthesia: a randomised, prospective, double-blind study[J]. Br J Anaesth,2022,129(1):49-57.
Sheng X Y,Liang Y,Yang X Y,et al.Safety,pharmacokinetic and pharmacodynamic properties of single ascending dose and continuous infusion of remimazolam besylate in healthy Chinese volunteers[J].Eur J Clin Pharmacol,2020,76(3):383-391.
[15]
Liu G,Xiong Y.Analysis of stress response and analgesic effect of remazolam combined with etomidate in painless gastroenteroscopy[J]. Contrast Media Mol I,2022,3:4863682.
[16]
Zhang X,Li S,Liu J.Efficacy and safety of remimazolam besylate versus propofol during hysteroscopy: single-centre randomized controlled trial[J]. BMC Anesthesiol,2021,21(1):156.
Jürgen Schüttler M D.Pharmacokinetics and pharmacodynamics of remimazolam (CNS7056) after continuous infusion in healthy male volunteers[J]. Anesthesiology,2020,132: 636-651.
[20]
Chen S,Wang J. The efficacy and safety of remimazolamtosylate versus propofol in patients undergoing colonoscopy: a multicentered, randomized, positive-controlled, phase III clinical trial[J].Am J Transl Res,2020,12(8):4594-4603.
2024, Vol. 35 
