| Effects of remimazolam versus dexmedetomidine on recovery after transcatheter aortic valve replacement under monitored anesthesia care: a propensity score-matched, non-inferiority study |
|
Ji-Hyeon Kim, Jae-Sik Nam, Wan-Woo Seo, Kyung-Woon Joung, Ji-Hyun Chin, Wook-Jong Kim, Dae-Kee Choi, In-Cheol Choi |
|
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea |
Corresponding author:
Jae-Sik Nam, Tel: +82-2-3010-1979, Fax: +82-2-470-1363,
Email: jaesik_nam@naver.com
|
|
Received: 26 February 2024 • Revised: 15 June 2024 • Accepted: 5 July 2024 |
|
|
| Abstract |
Background
Minimalist transcatheter aortic valve replacement (TAVR) under monitored anesthesia care (MAC) emphasizes early recovery. Remimazolam is a novel benzodiazepine with a short recovery time. This study hypothesized that remimazolam is non-inferior to dexmedetomidine in terms of recovery after TAVR.
Methods
In this retrospective observational study, remimazolam was compared to dexmedetomidine in patients who underwent TAVR under MAC at a tertiary academic hospital between July 2020 and July 2022. The primary outcome was timely recovery after TAVR, defined as discharge from the intensive care unit within the first day following the procedure. Propensity score matching was used to compare timely recovery between remimazolam and dexmedetomidine, applying a non-inferiority margin of -10%.
Results
The study included 464 patients, of whom 218 received remimazolam and 246 received dexmedetomidine. After propensity score matching, 164 patients in each group were included in the analysis. Regarding timely recovery after TAVR, remimazolam was non-inferior to dexmedetomidine (152 of 164 [92.7%] in the remimazolam group versus 153 of 164 [93.3%] in the dexmedetomidine group, risk difference [95% CI]: -0.6% [-6.7% to 5.5%]). The use of remimazolam was associated with fewer postoperative vasopressors/inotropes (21 of 164 [12.8%] vs. 39 of 164 [23.8%]) and temporary pacemakers (TPMs) (76 of 164 [46.3%] vs. 108 of 164 [65.9%]) compared to dexmedetomidine.
Conclusions
In patients undergoing TAVR under MAC, remimazolam was non-inferior to dexmedetomidine in terms of timely recovery. Remimazolam may be associated with better postoperative recovery profiles, including a lesser need for vasopressors/inotropes and TPMs.
|
| Key Words:
Benzodiazepines; Conscious sedation; Dexmedetomidine; Heart valve prosthesis implantation; Propensity score; Remimazolam |
|
PDF Links
Full text via DOI
Download Citation
