Effects of remazolam and midazolam on hemodynamics and sedation in patients with hip fracture in perioperative period

Objective To explore the effects of remazolam and midazolam on hemodynamics and sedation in patients with hip fracture in perioperative period.

Methods A total of 112 patients with selective hip fracture surgery were randomly divided into observation group (n=60) and control group (n=62). Patients in both group were conducted with combined spinal-epidural anesthesia before surgery, and the control group received intravenous infusion of 0.05 mg/kg midazolam for sedation, followed by continuous infusion of 0.05 mg/(kg·h) in purpose of reducing the bispectral index (BIS) to 75; the observation group received intravenous injection of 0.3 mg/kg remazolam, followed by continuous infusion of 5 μg/(kg·min) in purpose of reducing the BIS to 75. At the time points of after stable block level (T₀), BIS decreasing to < 75 (T₁), 30 minutes afterthe start of surgery (T₂), drug withdrawal (T₃) and BIS increasing to >90 after drug withdrawal (T₄), the indexes such as oxygen saturation of blood (SpO₂), respiratory rate (RR), heart rate (HR), mean arterial pressure(MAP) and BIS were compared between the two groups. The onset time of sedation, awake time and adverse reactions were compared between the two groups.

Results In the observation group, the SpO₂ and RR at T₂ were significantly higher than those in the control group (P < 0.05 or P < 0.01). HR at T₁ and T₂ in the observation group was significantly higher than that at T₀, while HR at T₃ and T₄ was significantly lower than that at T₁ and T₂ (P < 0.05); HR at T₁ to T₄ in the control group was significantly lower than that at T₀ (P < 0.05); HR at T₁ and T₂ in the observation group was significantly higher than that in the control group (P < 0.05). MAP at T₁ to T₄ in the observation group was lower than that at T₀ (P>0.05); MAP at T₁ to T₄ in the control group was significantly lower than that at T₀ (P < 0.05); MAP at T₁ and T₂ in the observation group was significantly higher than that in the control group (P < 0.05). BIS at T₁ to T₃ in both groups decreased significantly when compared to that at T₀ (P < 0.05); BIS at T₁ and T₂ in the observation group was significantly lower than that in the control group (P < 0.05). The awake time and onset time of sedation in the observation group were (6.71±2.72) and (1.81±0.92) minutes respectively, which were significantly shorter than (11.49±3.19) and (3.77±1.04) minutes in the control group (P < 0.05). There were no significant differences in adverse reactions such as bradycardia, hypotension and respiratory depression caused by the drugs between two groups (P>0.05).

Conclusion In hip fracture surgery, remazolam can be used as an adjunct for sedation. Compared with midazolam, remazolam has advantages such as less impact on hemodynamics, ideal sedative effect, faster recovery and fewer adverse reactions.