Most of the major spinal surgeries are performed in the supine position, which causes a decrease in stroke volume and cardiac index, which leads to the occurrence of hypotension during surgery. Postoperative hypotension causes an imbalance in the supply and demand of oxygen, leading to postoperative myocardial infarction or acute renal damage, and may increase mortality one year after surgery. Propofol, which is most commonly used for total intravenous anesthesia, can further increase the incidence of hypotension during surgery. Therefore, there is a continuing demand for an anesthetic agent that is more hemodynamically stable. Remimazolam, an ultra-short acting benzodiazepine that has a similar structure to midazolam, but whose activity is terminated by esterase hydrolysis, is expected to have less hemodynamic effects than propofol. Therefore, the purpose of this study is to investigate the effect of general anesthesia using remimazolam and general anesthesia using propofol on hemodynamic safety during surgery in patients undergoing major spinal surgery in the supine position.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
94
Remimazolam: loading (6mg/kg/hr) + continuous infusion (1-2mg/kg/hr)
Propofol: target controlled infusion: 2-3mcg/mL
Asan Medical Center
Seoul, Seoul, South Korea
the number of hypotensive episode per patient
SAP \< baseline SBP \* 80% or 90mmHg // MAP \< baseline MAP \* 80% or 65mmHg
Time frame: for one hour after turning the patients to the prone position
the number of severe hypotensive episode per patient
SAP \< baseline SBP \* 70% or 80mmHg // MAP \< baseline MAP \* 70% or 55mmHg
Time frame: for one hour after turning the patients to the prone position
cardiac index
cardiac index from Flotrac
Time frame: for one hour after turning the patients to the prone position
pleth variability index
pleth variability index
Time frame: for one hour after turning the patients to the prone position
heart rate
heart rate from EKG
Time frame: for one hour after turning the patients to the prone position
Total opioid consumption
amount of total opioid administered
Time frame: for one hour after turning the patients to the prone position
cardiac output
cardiac output from Flotrac
Time frame: for one hour after turning the patients to the prone position
stroke volume
stroke volume from Flotrac
Time frame: for one hour after turning the patients to the prone position
stroke volume variation
stroke volume variation from Flotrac
Time frame: for one hour after turning the patients to the prone position
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