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瑞马唑仑对脊柱手术中经颅电运动诱发电位的影响：一项前瞻性初步剂量递增研究
贵州医科大学 麻醉与心脏电生理课题组
翻译：严旭 编辑：杨荣峰 审校：曹莹
有些麻醉药物会降低经颅电运动诱发电位（MEP）的幅度。瑞马唑仑是一种新型苯二氮䓬类药物，研究表明其对MEP幅度的影响较小。本项前瞻性初步剂量递增研究旨在评估瑞马唑仑是否与MEP幅度降低有关，并且是否具有剂量依赖性。
研究纳入了10名计划进行后路脊柱融合术的成年患者。麻醉通过持续输注瑞芬太尼和瑞马唑仑诱导。患者失去意识后，瑞马唑仑的输注速度设定为1mg/kg/h，并进行气管插管。在1mg/kg/h瑞马唑仑的输注下，患者处于俯卧位，记录基线MEP。随后，瑞马唑仑的输注速率增加至2mg/kg/h，并给予0.1mg/kg的推注。增加剂量10分钟后再次记录诱发电位。主要观察指标为两次时间点左侧腓肠肌MEP幅度的记录值。
在增加瑞马唑仑剂量前后，左侧腓肠肌的MEP幅度没有显著差异（中位数[四分位数范围]：分别为0.93 [0.65-1.25] mV和0.70 [0.43-1.26] mV；P=0.08）。停止瑞马唑仑给药后，平均4分钟内使用氟马西尼即可进行神经系统检查。
本项初步研究表明，将瑞马唑仑剂量从1mg/kg/h增加到2mg/kg/h，对经颅电MEP的影响较小。
原始文献来源：Kurita S, Furutani K, Mitsuma Y, et,al. Effect of Remimazolam on Transcranial Electrical Motor-evoked Potential in Spine Surgery: A Prospective, Preliminary, Dose-escalation Study[J]. J Neurosurg Anesthesiol, 2024 Jul 22. doi: 10.1097/ANA.0000000000000983.
Effect of Remimazolam on Transcranial Electrical Motor-evoked Potential in Spine Surgery: A Prospective, Preliminary, Dose-escalation Study
Abstract
Background: Some anesthetic drugs reduce the amplitude of transcranial electrical motor-evoked potentials (MEPs). Remimazolam, a new benzodiazepine, has been suggested to have little effect on MEP amplitude. This prospective, preliminary, dose-escalation study aimed to assess whether remimazolam is associated with lower MEP amplitude in a dose-dependent manner.
Methods: Ten adult patients scheduled for posterior spinal fusion were included in this study. General anesthesia was induced with a continuous infusion of remifentanil and remimazolam. After the patient lost consciousness, the infusion rate of remimazolam was set to 1 mg/kg/h, and the patient underwent tracheal intubation. Baseline MEPs were recorded under 1 mg/kg/h of remimazolam in a prone position. Thereafter, the infusion rate of remimazolam was increased to 2 mg/kg/h, with a bolus of 0.1 mg/kg. Ten minutes after the increment, the evoked potentials were then recorded again. The primary endpoint was the MEP amplitude recorded in the left gastrocnemius muscle at 2 time points.
Results: There was no difference in MEP amplitude recorded from the left gastrocnemius muscle before and after increasing remimazolam (median [interquartile range]: 0.93 [0.65 to 1.25] mV and 0.70 [0.43 to 1.26] mV, respectively; P=0.08). The average time from the cessation of remimazolam administration to neurological examination after surgery was 4 minutes using flumazenil.
Conclusions: This preliminary study suggests that increasing remimazolam from 1 to 2 mg/kg/h might have an insignificant effect on transcranial electric MEPs.
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