In patients undergoing transurethral resection of bladder, the effect of remimazolam-based monitored anesthesia care (MAC) and inhalational general anesthesia will be compared under guidance by analgesia nociception index (ANI) monitoring. Anesthesia time, operation time, anesthesia time excluding operation time and total dose of opioid will be compared.
In remimazolam-based MAC group, anesthesia will be induced with remimazolam and spontaneous breathing will be maintained. The dose of remimazolam and remifentanil will be adjusted according to the patient state index (PSI) and the analgesia nociception index(ANI). In inhalation general anesthesia group, anesthesia will be induced with propofol and rocuronium and maintained with sevoflurane and remifentanil. Mechanical ventilation will be maintained by inserting laryngeal mask airway (LMA) or endotracheal tube. The doses of sevoflurane and remifentanil will be adjusted according to the patient state index (PSI) and the analgesia nociception index(ANI). Surgery cost, anesthesia cost, patient and surgeon's satisfaction score, pain score, PONV score and the incidence of hypotension and hypoxemia will be compared.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
46
The surgery will be performed under monitored anesthesia care by maintaining spontaneous breathing using remimazolam.
The surgery will be performed under mechanical ventilation with inhalation general anesthesia
Yonsei university college of medicine
Seoul, South Korea
anesthesia time excluding operation time
anesthesia time excluding operation time
Time frame: 0-1 hour after the end of surgery (Time point at which patient exit the operating room)
surgery cost and anesthesia cost
surgery cost and anesthesia cost: insured cost and non-insured cost
Time frame: 1 month after surgery
surgeon's satisfaction score
surgeon's satisfaction score: very poor (1)/ poor (2)/ satisfactory (3)/ good (4)/excellent (5)
Time frame: At the end of surgery
patient's satisfaction score
patient's satisfaction score: very poor (1)/ poor (2)/ satisfactory (3)/ good (4)/excellent (5)
Time frame: 0-2 hour after surgery (Time points at patient discharge from recovery room)
pain score
pain score : NRS 0-10 The numerical rating scale requires the patient to rate their pain or nausea/vomiting on a defined scale. Numerical rating scale (NRS) is the simplest and most commonly used scale. The numerical scale is most commonly 0 to 10, with 0 being "no pain or no nausea/vomiting" and 10 being "the worst pain or nausea/vomiting imaginable.
Time frame: 0-2 hour after surgery (Time points at patient discharge from recovery room), and 6 hour after surgery
PONV score
PONV was defined as nausea or vomiting score.
Time frame: 0-2 hour after surgery (Time points at patient discharge from recovery room), and 6 hour after surgery
incidence of hypotension
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hypotension: baseline BP reduction (20%)
Time frame: At the end of surgery
incidence of hypoxemia
hypoxemia : unresponsive to a jaw thrust maneuver and SPO2 \<92%
Time frame: At the end of surgery