Remimazolam Proves Effective in Reducing Extubation Time for Elderly Patients Undergoing TAVI

A recent study has highlighted the potential benefits of using remimazolam over sevoflurane in anesthesia for elderly patients undergoing transcatheter aortic valve implantation (TAVI). Conducted in Japan, this prospective, open-label, single-center clinical trial was led by Dr. So Harimochi from the Department of Anesthesiology and Critical Care Medicine at Kagoshima University. The study involved 60 patients aged over 75 years, randomly assigned to receive either intravenous (IV) remimazolam or sevoflurane for maintaining general anesthesia.

The analysis included 56 patients, focusing on comparing emergence times between those administered sevoflurane and those given remimazolam plus flumazenil. Patients undergoing TAVI under general anesthesia received a continuous remifentanil infusion throughout the procedure. In the remimazolam cohort, flumazenil was administered immediately after discontinuing remimazolam.

Findings revealed that the median time to extubation was significantly reduced in the remimazolam group compared to the sevoflurane group, with times of 6.5 minutes versus 14.2 minutes, respectively (P <.001). Moreover, patients receiving remimazolam required lower bolus doses of ephedrine than those administered sevoflurane, showing a median difference of −4 mg.

Despite these differences, no significant variations were observed between the two groups concerning mean arterial pressure, heart rate, or the use of other vasopressors. However, the study noted that the perfusion index and regional cerebral oxygen saturation were significantly lower in the remimazolam group. The researchers did not consider these differences clinically significant, maintaining focus on the primary outcomes related to extubation time and medication dosing.

The study's results were published online on December 23, 2024, in the Canadian Journal of Anesthesia. This landmark research underscores the potential for improved patient outcomes in elderly individuals undergoing complex cardiac procedures by optimizing anesthesia protocols.