journal reading (kurnia). quality post operative recovery in TIVA between remimazolam and propofol .pdf

tiva

1. Quality of Postoperative Recovery in Total Intravenous
Anesthesia between Remimazolamand Propofolfor
Intraoperative Neurophysiological Monitoring: A Prospective
Double-Blind Randomized Controlled Trial
1
Nama: MuhamadKurnia Sandy
NIM : G5A024001

2. 2

3. Remimazolam vs.
Propofol: Properties
3
Remimazolamis a benzodiazepine
with rapid onset and short duration
of action. It has a context-sensitive
half-life, metabolism independent of
hepatic or renal function, and
produces an inactive metabolite.
These properties make it a promising
agent for TIVA.
Remimazolam Propofol
Propofolis a widely used intravenous
anesthetic with rapid onset and short
duration of action. It is favored for its
anti-emetic properties and ease of
titration. However, its use can be
associated with certain drawbacks
such as injection pain, hemodynamic
instability, and propofolinfusion
syndrome.

4. Materials and
Methods
4
-Thisprospective,double-blind,randomizedcontrolledtrialwas
conductedatatertiaryhospital.
-Thestudypopulationcomprisedindividualsaged20–70years,with
anAmericanSocietyofAnesthesiologistsphysicalstatusranging
fromItoIII
-PatientswererecruitedfromDecember2021toJuly2023.
-Theexclusion:onalcoholorpsychotropicsubstances,thosewith
benzodiazepinehypersensitivityortolerance,bodymassindex
exceeding30kg/m2.
Theaimwastocomparepostoperativerecoveryqualitybetween
remimazolamandpropofolusingtheQoR-15questionnaire.The
studyinvolved72patientsundergoingspinesurgerywith
intraoperativeneurophysiologicalmonitoring,categorizedintotwo
groupsforstatisticalanalysis.

5. Materials and Methods: Patient characteristics.
5

6. Materials and
Methods:Intervention
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ingroupP:anesthesiainductionusing0.1mgofglycopyrrolate,40mgof
lidocaine,targetedcontrolledinfusion(TCI)ofpropofol(Fresofol2%injection50
Ml)setat3.0ngmL-1vial,aswellasTCIofremifentanilat3.0ngmL-1
groupR:anesthesiainitiationinvolved0.1mgofglycopyrrolate,along
withthecommencementofainfusion,spanning6–12mgkgand
maintainedat1.0–2.0mgkgafterlossofconsciousnesspairedwitha
TCIofremifentanilat3.0ngmL−1.

7. 7
Materials and Methods:Primary Outcome, QoR-15 Scores, ,
Statistical Analyses
50% 50%
Propofol Group
Patients in the Propofolgroup had
an average QoR-15 score of 114,
indicating a good quality of
recovery without significant
statistical difference compared to
the Remimazolamgroup.
Remimazolam Group
Patients in the Remimazolam
group scored an average QoR-15
of 112. The difference with the
Propofol group was not
statistically significant, signifying
similar recovery quality.
-Thequestionnaire->physicalcomfort(Q1,2,3,4,13),emotionalstate(Q9,
10,14,15),psychologicalsupport(Q6,7),physicalindependence(Q5,8),and
pain(Q11,12).
-Distributionofpatientcharacteristicsandperioperativevariables
usingtheShapiro–Wilktest.
-Differencesbetweengroups:independenttwo-samplet-test
(continuousvariables)andtestforcategoricalvariables.theChi-
squareorFisher’sexact
-Statistical analyses using SAS software.
-Statistical significance was established at a two-sided p-value of <0.05.

8. Results
8
-on POD1 (114 [±20.1] vs. 112 [±23.1], p = 0.691).
-The preoperative scores (p = 0.032 in group P, p = 0.007 in group R).
-on POD 2 improved significantly in both groups compared to POD1
(p < 0.001)

9. Intraoperative Parameters
9

10. Parameter Group P (Propofol) Group R (Remimazolam)
MAP (mean arterial pressure) Stable, but with more variability More stable over time
Heart Rate Slightly fluctuates More consistent
Peripheral Oxygen Saturation Consistent Consistent
PSI (Patient State Index) Variable More stable
Hemodynamic Parameters
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Perioperative data

11. Perioperative data
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12. 12
Postoperative Pain Intensity
60% 40%
Pain in Propofol Group
The Propofol group reported a
postoperative pain intensity score
of 3.0 at rest in the PACU,
indicating higher pain levels
compared to the Remimazolam
group.
Pain in Remimazolam Group
The Remimazolam group reported
a lower postoperative pain
intensity score of 2.8 at rest in the
PACU, signifying better pain
management.

13. Postoperative recovery profiles
13

14. Discussion
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The study highlights the suitability of Remimazolamas an
alternative to Propofolfor TIVA in spine surgery. While both
agents provide comparable QoR-15 scores, Remimazolam
offers better hemodynamic stability, shorter awakening
times, and effective pain control. These findings can
influence the choice of anesthetic agents in clinical practice,
especially for surgeries requiring neurophysiological
monitoring.
Interpreting the Results

15. Aspect Remimazolam Propofol
Cost Higher Lower
Antidote Availability Yes No
Risk of Infusion Syndrome No Yes
Hemodynamic Stability More stable Less stable
Postoperative Recovery Faster Slower
Conclusions
Cost Comparison and Benefits
15

16. Key Study Limitations
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The study did not compare
intraoperative neurophysiological
signals. This data is crucial for
understanding the full impact of
anesthetics on neurophysiological
functions.
Neurophysiological Monitoring Uniform Anesthesia Depth Sample Size
The depth of anesthesia was
uniformly applied without accounting
for drug differences. Remimazolam
and Propofolaffect
electroencephalogram readings
differently, which could affect
intraoperative and postoperative
outcomes.
A small sample size limits the
generalizability of the findings. Larger
studies are needed to confirm these
results and evaluate the performance
of these anesthetics in diverse
populations.

17. Thank you
17

18. JBI Critical Appraisal Checklist for Randomized Controlled Trials

Yes No Unclear NA


1. Was true randomization used for assignment of participants to treatment
groups?  □ □ □
2. Was allocation to treatment groups concealed?
 □ □ □
3. Were treatment groups similar at the baseline?
 □ □ □
4. Were participants blind to treatment assignment?
 □ □ □
5. Were those delivering treatment blind to treatment assignment?
 □ □ □
6. Were outcomes assessors blind to treatment assignment?
 □ □ □
7. Were treatment groups treated identically other than the intervention of
interest?  □ □ □
8. Was follow up complete and if not, were differences between groups in
terms of their follow up adequately described and analyzed?  □ □ □
9. Were participants analyzed in the groups to which they were randomized?
 □ □ □
10. Were outcomes measured in the same way for treatment groups?
 □ □ □
11. Were outcomes measured in a reliable way?
 □ □ □
12. Was appropriate statistical analysis used?
 □ □ □

13. Was the trial design appropriate, and any deviations from the standard RCT
design (individual randomization, parallel groups) accounted for in the
conduct and analysis of the trial?
 □ □ □


Overall appraisal:
Include □ Exclude □ Seek further info □
Comments (Including reason for exclusion)