Clinical Interventions in Aging (May 2022)
The Median Effective Dose and Bispectral Index of Remimazolam Tosilate for Anesthesia Induction in Elderly Patients: An Up-and-Down Sequential Allocation Trial
Abstract
Miao Liu,1– 3 Yuan Sun,1– 3 Lingxue Zhou,1– 3 Kunpeng Feng,1– 3 Tianlong Wang,1– 3 Xuexin Feng1– 3 1Department of Anesthesiology, Capital Medical University Xuanwu Hospital, Beijing, People’s Republic of China; 2Center for Sleep and Consciousness Disorders, Capital Medical University, Beijing, People’s Republic of China; 3Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Xuexin Feng, Department of Anesthesiology, Capital Medical University Xuanwu Hospital, No. 45 Changchun St., Xicheng District, Beijing, 100053, People’s Republic of China, Tel +86-1083798277, Email [email protected]: Remimazolam is a new type of ultrashort benzodiazepine drug with an unclear optimal dose for general anesthesia induction in elderly patients aged > 60 years. Therefore, this study aimed to determine the effective dose of remimazolam tosilate induction and explore its correlation with the bispectral index (BIS).Patients and Methods: A total of 42 elderly patients were divided into two age groups: 60– 69 (group A) and 70– 85 (group B) years. An initial dose of 0.1mg/kg(Group A) and 0.05 mg/kg(Group B) remimazolam tosilate was administered, and the Modified Observer’s Assessment of Alertness/Sedation scale was used to assess adequate responses. The dose was calculated using the up-and-down allocation technique based on the previous response. The sequential formula and probit regression model were used to calculate ED50 and BIS50. ED95 was determined using the probit regression model.Results: The ED50 of remimazolam tosilate for anesthesia induction were 0.088 mg/kg (95% confidence interval [CI] 0.071– 0.108) and 0.061 mg/kg (95% CI 0.053– 0.069) in groups A and B, respectively. ED95 was 0.118 mg/kg (95% CI 0.103– 0.649) and 0.090 mg/kg (95% CI 0.075– 0.199) in groups A and B, respectively. The remimazolam tosilate administration could decrease BIS. BIS50 was 86.0 (95% CI 83.7– 88.6) and 85.4 (95% CI 84.1– 86.8) in groups A and B, respectively.Conclusion: During the induction process, patients’ consciousness should be observed. The dose of remimazolam tosilate could be chosen after careful consideration of individual variations.Keywords: remimazolam, anesthesia induction, geriatric, up-and-down sequential allocation
