The effect of an eye mask on midazolam requirement for sedation during spinal anesthesia: a randomized controlled trial

Effects of Earmuffs and Eye Masks on Propofol Sedation during Spinal Anesthesia for Orthopedic Surgery: A Randomized Controlled Trial

Intravenous sedative drugs are commonly administered during regional anesthesia. However, reducing the excessive use of sedatives while providing adequate sedation is important from the clinical perspective, since the use of sedatives can cause considerable complications. We hypothesized that the application of earmuffs and eye masks would help reduce the sedative dose required to maintain proper sedation by blocking external stimuli. Patients who underwent orthopedic surgery under spinal anesthesia were randomly allocated to the control (no intervention) or intervention group (wearing earmuffs and eye masks). Intravenous sedation was administered using target-controlled infusion of propofol. The target concentration was controlled to maintain a Modified Observer's Assessment of Alertness and Sedation score of 3 or 4. The primary outcome was the intraoperative propofol requirement. We also investigated the incidence of apnea, and patient satisfaction. Propofol requirement was significantly lower in the intervention group than that in the control group (2.3 (2.0-2.7) vs. 3.1 (2.7-3.4) mg·kg^-1·h^-1; p < 0.001). Intraoperative apnea occurred less frequently (p = 0.038) and patient satisfaction was higher (p = 0.002) in the intervention group compared to the control group. This study demonstrated that the use of earmuffs and eye masks during sedation was associated with lower propofol requirement and improved sedation quality.

The hemodynamic stability of remimazolam compared with propofol in patients undergoing endoscopic submucosal dissection: A randomized trial

Objective

Hypotension is common in propofol anesthesia. Whether remimazolam could reduce intraoperative hypotension remains unknown. We therefore tested the primary hypothesis that remimazolam reduces the incidence of intraoperative hypotension compared with propofol in adult patients undergoing endoscopic submucosal dissection (ESD) surgery.

Materials and methods

We conducted a prospective trial to compare patients who received either remimazolam or propofol bolus induction and thereafter intravenous infusion. The hemodynamic parameters were measured using CNAP® Monitor 500 system. Our primary analysis was to compare the incidence of hypotension defined as systolic blood pressure below 90 mmHg between remimazolam and propofol during the whole anesthesia period.

Results

The incidence of hypotension decreased by 50%, from 67.9% in propofol group to 32.1% in remimazolam group (p &lt; 0.01). Patients received less amount of intraoperative phenylephrine in the remimazolam group than the propofol group (0 [0–40] μg vs. 80 [0–200] μg, p &lt; 0.01). Time-weighted average and cumulative time of hypotension was lower in remimazolam group compared with propofol group (p &lt; 0.05). Cardiac output continuously measured by CNAP was preserved much better in remimazolam group compared with propofol group (p = 0.01), while systemic vascular resistance did not differ between the groups. The median time from discontinuation until full alertness was 4 [3–11.8] min in the remimazolam group compared with 15 [12.0–19.8] min in the propofol group (p &lt; 0.01).

Conclusion

Remimazolam has better hemodynamic stability than propofol in adult patients undergoing ESD surgery. The benefits of remimazolam on hemodynamic stability and hypotension prevention may be partly contributed to its better preservation of cardiac output.

Clinical Trial Registration

[http://www.chictr.org.cn/com/25/showproj.aspx?proj=61104], identifier [ChiCTR2000037975].