Journal of anesthesia · 2025
Impact of the choice of general anesthesia agent on peri-operative oxygen supply-demand balance: a prospective quasi-randomized controlled trial comparing propofol and remimazolam.
СтатьяРандомизированное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Yarimizu Kenya, Kuroki Masahiro, Soekawa Kiyotaka, Hayasaka Tatsuya, Onodera Yu, Suzuki Hiroto, Toyama Hiroaki, Kawamae Kaneyuki
Аннотация
PURPOSE: To compare the effects of propofol and remimazolam on peri-operative oxygen supply-demand balance.
METHODS: This prospective quasi-randomized controlled trial was carried out in a single tertiary care university hospital between January and October 2022, with patients (n = 50) aged 18-85 years undergoing major abdominal surgery. General anesthesia was induced and maintained with propofol or remimazolam. The primary endpoints were peri-operative oxygen consumption (VO2) and carbon dioxide production (VCO2). The secondary endpoints were oxygen delivery (DO2) and the respiratory quotient (RQ). These were measured using indirect calorimetry and arterial pressure waveform analysis for cardiac output monitoring. Time-series changes in these parameters were analyzed to compare the effects of the anesthetics on oxygen supply-demand balance. The associations among the choice of anesthetic agent, patient characteristics, and VCO2 levels were investigated.
RESULTS: Anesthesia induction significantly decreased VO2, VCO2, DO2, and RQ. The reduction in VO2, VCO2, DO2, and RQ in the propofol and remimazolam groups was 17.6% [IQR: -0.55-27.8] vs 17.4% [10.3-31.6] (P = 0.47), 26.1% [5.2-40.5] vs 31.2% [16.2-42.6] (P = 0.59), 24.4% [1.0-35.2] vs 20.7% [15.4-32.8] (P = 0.93), and 10.3% [4.4-16.7] vs 10.4% [-4.7-21.6] (P = 0.71), respectively. A weak association between anesthesia choice and VCO2 concentrations was observed. Patients with higher VCO2 were younger, with better cardiac function than those with lower VCO2.
CONCLUSIONS: Anesthesia induction suppressed metabolism. However, the choice of general anesthetic for scheduled major abdominal procedures did not significantly affect the oxygen supply-demand balance.
TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry identifier: UMIN000046531.
METHODS: This prospective quasi-randomized controlled trial was carried out in a single tertiary care university hospital between January and October 2022, with patients (n = 50) aged 18-85 years undergoing major abdominal surgery. General anesthesia was induced and maintained with propofol or remimazolam. The primary endpoints were peri-operative oxygen consumption (VO2) and carbon dioxide production (VCO2). The secondary endpoints were oxygen delivery (DO2) and the respiratory quotient (RQ). These were measured using indirect calorimetry and arterial pressure waveform analysis for cardiac output monitoring. Time-series changes in these parameters were analyzed to compare the effects of the anesthetics on oxygen supply-demand balance. The associations among the choice of anesthetic agent, patient characteristics, and VCO2 levels were investigated.
RESULTS: Anesthesia induction significantly decreased VO2, VCO2, DO2, and RQ. The reduction in VO2, VCO2, DO2, and RQ in the propofol and remimazolam groups was 17.6% [IQR: -0.55-27.8] vs 17.4% [10.3-31.6] (P = 0.47), 26.1% [5.2-40.5] vs 31.2% [16.2-42.6] (P = 0.59), 24.4% [1.0-35.2] vs 20.7% [15.4-32.8] (P = 0.93), and 10.3% [4.4-16.7] vs 10.4% [-4.7-21.6] (P = 0.71), respectively. A weak association between anesthesia choice and VCO2 concentrations was observed. Patients with higher VCO2 were younger, with better cardiac function than those with lower VCO2.
CONCLUSIONS: Anesthesia induction suppressed metabolism. However, the choice of general anesthetic for scheduled major abdominal procedures did not significantly affect the oxygen supply-demand balance.
TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry identifier: UMIN000046531.