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Adjuvants, Anesthesia

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Remazolam 0.4 mg/kg, oxycodone 0.2 mg/kg and rocuronium 0.9 mg/kg were given for anesthesia induction.Group R was given remazolam 1mg/kg/h and remifentanil 6-8ug/kg/h for maintenance.

Propofol 1.5mg/kg, oxycodone 0.2mg/kg and rocuronium 0.9mg/kg were given for induction of anesthesia.Group P was given propofol 4-8 mg/kg/h and remifentanil 6-8ug/kg/h for anesthesia maintenance.

Remimazolam is a new drug innovation in anesthesia. It combines the properties of two unique drugs already established in anesthesia - Midazolam and remifentanil. It acts on GABA receptors like midazolam and has organ-independent metabolism like remifentanil.

Remimazolam

Propofol is used to put you to sleep and keep you asleep during general anesthesia for surgery or other medical procedures.

Rocuronium is a non-depolarizing neuromuscular blocker

Remifentanil is an esterase-metabolized opioid

oxycodone

Sugammadex sodium is an organic sodium salt that is the octasodium salt of sugammadex. Used for reversal of neuromuscular blockade induced by rocuronium and vecuronium in adults undergoing surgery

Sugammadex Sodium

Flumazenil is used to reverse the effects of a benzodiazepine

This study is a prospective, randomized, controlled trial. In this study, 30 patients who underwent endotracheal tumor resection under rigid bronchoscope or stent placement for acquired tracheoesophageal fistula were selected as the subjects. The patients were randomly divided into remazolam general anesthesia group (R group) and propofol general anesthesia control group (P group). Remazolam general anesthesia group (R group): Remazolam 0.4 mg/kg, oxycodone 0.2 mg/kg and rocuronium 0.9 mg/kg were given for anesthesia induction. Propofol general anesthesia control group (P group): Propofol 1.5mg/kg, oxycodone 0.2mg/kg and rocuronium 0.9mg/kg were given for induction of anesthesia. After induction, high-frequency jet ventilation was used in both groups, the respiratory rate was 30-60 times/min, the inspiratory-to-breath ratio was 1:2, and the driving pressure was 0.8-1.0 KPa. Group R was given remazolam 1mg/kg/h and remifentanil 6-8ug/kg/h for maintenance. Group P was given propofol 4-8 mg/kg/h and remifentanil 6-8ug/kg/h for anesthesia maintenance. The dosage of propofol or remazolam was adjusted according to BIS and intraoperative hemodynamic changes. Rocuronium bromide 10 mg was added every half hour. Intraoperative application of vasoactive drugs to maintain mean arterial pressure above 60mmHg to avoid perioperative hypotension. Blood oxygen saturation and end-tidal carbon dioxide were monitored to avoid perioperative hypoxemia and hypercapnia, and warm measures were used to maintain the patient's intraoperative body temperature above 36.0°C. After surgery, group R was treated with sugammadex sodium 2-4 mg/kg to antagonize rocuronium bromide, and 0.5 mg of flumazenil was used to antagonize remazolam by intravenous injection; group P was treated with sugammadex 2-4 mg/kg to antagonize rocuronium.

Clinical Application Value of Remazolam Combined With Sugammadex Sodium in Anesthesia for Endotracheal Surgery Under Bronchoscopy

Department of Anesthesiology, Cancer Hospital of the University of Chinese Academy of Sciences（Zhejiang Cancer Hospital), Research Center for Neuro-Oncology Interaction , Institute of Basic Medicine and Cancer, Chinese Academy of Sciences

Taking the stop of general anesthesia as the starting point for timing, the time for the patient to correctly complete the three commands of nodding, mouth opening and tongue extension is recorded, with seconds as the timing unit

Modified Brice interview over quality assurance techniques in detecting intraoperative awareness.

Fluctuations in intraoperative systolic, diastolic pressures and mean arterial pressure will be recorded

PONS is a modified version of the malnutrition universal screening tool and determines the presence of nutrition risk based on BMI, recent body weight loss, decrement of dietary intake, and preoperative albumin concentration.

The time from the start of peripheral intravenous injection of general anesthetic to the patient's loss of consciousness. Time is measured in seconds.

The proportion of cases of postoperative delirium in the enrolled patients

Fluctuations in intraoperative heart rate will be recorded

The proportion of cases of postoperative vomiting in the enrolled patients

Zhejiang Cancer Hospital

Clinical Professor

Frailty

Delayed Emergence from Anesthesia

Postoperative Complications

Patient receive TOF nerve stimulation in recovery room after surgery

Patient receive nerve stimulation by TOF-scan equipment at recovery room after surgery.

Train of four nerve stimulator

Patchareya Nivatpumin, M.D.

Jitsupa Nithiuthai, M.D.

Nutthavit Hantayapong, M.D.

Frailty among patients undergoing surgery is strongly associated with an elevated risk of adverse perioperative outcomes, heightened incidence of postoperative complications, increased mortality rates, and prolonged hospital length of stay. Our focus centers on investigating the frailty index in the context of complications experienced by patients undergoing oncologic gynecology surgery. The principal objective of this research is to elucidate the extent to which residual neuromuscular blocking agents are linked to frailty.

Among patients undergoing oncologic gynecological procedures, such as those for vulvar cancer, endometrial cancer, and ovarian cancer, the incidence of frailty has been observed to range from 14% to 45%. Frailty directly influences the metabolism of anesthetic agents and intraoperative management. Furthermore, the prevalence of residual neuromuscular blocking agents following surgery can be as high as 26% to 53%. No prior research has investigated the correlation between residual muscle relaxants and frailty in gynecologic oncology patients. This study is designed to assess the prevalence of residual muscle relaxants in these patients with frailty. Additionally, data on the incidence of frailty and its impact on postoperative outcomes and prognosis in patients undergoing gynecologic oncology surgery will be collected and reported.

Incidence of Residual Neuromuscular Blockade in Fraility in OncoGynae Surgery

Incidence of Residual Neuromuscular Blockade in Patients With Frailty Undergoing Gynecologic Cancer Surgery

Incidence of residual neuromuscular blockade with the relation of frailty after gynecologic oncology surgery

Incidence of frailty in patients undergoing gynecologic oncology surgery

Anesthetic technique used in patients undergoing gynecologic oncology surgery

Rate of vasopressor usage eg. ephedrine, norepinephrine

Number of patients who require intensive care unit admission after surgery

Number of patients who require re-intubation

Number of patients who require mechanical ventilation postoperative

Number of patients who have postoperative pulmonary complications eg. prolonged intubation, atelectasis, pneumonia etc.

Number of patients who died after surgery

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Clinical Application Value of Remazolam Combined With Sugammadex Sodium in Anesthesia for Endotracheal Surgery Under Bronchoscopy	NCT05468671	Endobronchial M... Bronchoesophage... General Anesthe...	Remimazolam Propofol Rocuronium Remifentanil oxycodone Sugammadex Sodi... Flumazenil	18 Years -	Zhejiang Cancer Hospital
Incidence of Residual Neuromuscular Blockade in Fraility in OncoGynae Surgery	NCT06216002	Frailty Neuromuscular B... General Anesthe... Gynecologic Can... Surgical Compli...	Train of four n...	18 Years -	Mahidol University

Spots Global Cancer Trial Database for general anesthetic drug adverse reaction