[Different combinations of anesthetics in transperineal prostate biopsy in elderly men: A prospective, randomized, controlled monocentric trial].

OBJECTIVE

To compare the clinical effects of different combinations of anesthetics in transperineal prostate biopsy in elderly male patients.

METHODS

We randomly divided 132 ≥65-year-old male patients to receive transperineal prostate biopsy under combined intravenous anesthesia with propofol + sufentanil (the PS group), remimazolam + sufentanil (the RS group), propofol + alfentanil (the PA group), or remimazolam + alfentanil (the RA group). We recorded the mean arterial pressure (MAP) and heart rate (HR) of the patients, the required rescue sedation, the Richmond Agitation-Sedation Scale (RASS) scores upon admission into the postanesthesia care unit (PACU) after surgery, the length of stay in the PACU and the incidence of adverse reactions, followed by comparison of the data obtained among the four groups.

RESULTS

Operations were successfully completed in all the patients. At 5 moment points from T3 to t2, RA and RS groups had less effect on MAP than PA and PS groups (P < 0.05); at 5 moment points from T1 to T5, RA and RS groups had less effect on HR than PA and PS groups (P<0.05), and this effect was more obvious in RA group than in RS group.During anesthesia-induction, the incidence rate of injection pain was remarkably lower in the RA and RS than in the PA and PS groups (P<0.05), and that of respiratory depression was higher in the PS than in the other three groups (P = 0.013). The RASS scores were significantly higher (P<0.05) and the PACU stay shorter in the RA and RS than in the PA and PS groups (P<0.05). Dramatically more cases of intraoperative body movement and remedial medication requirement were observed in the former than in the latter two groups (P = 0.013), but there was no statistically significant difference in the dose of remedial medication between the four groups of patients (P > 0.05).

CONCLUSION

For elderly male patients undergoing transperineal prostate biopsy under intravenous anesthesia with preservation of spontaneous breathing, the combined use of remimazolam and alfentanil can achieve more stable intraoperative hemodynamics, faster recovery from anesthesia and a lower incidence of perioperative adverse reactions, and produce an even better anesthetic effect with a small dose of propofol to suppress the body movement at the time of needle puncture.