To observe the clinical efficacy and safety of general anesthesia induction with different doses of remimazolam in the vascular interventional treatment of intracranial aneurysms, and observe the safety.

The patients with intracranial aneurysms who will receive vascular interventional treatment for intracranial aneurysms were divided into low-dose group (0.2 mg·kg^-1 remimazolam), middle-dose group (0.3 mg·kg^-1 remimazolam) and high-dose group (0.4 mg·kg^-1 remimazolam) according to cohoert. The three groups completed intravenous injection of 0.2-0.4 mg·kg^-1 remimazolam. When the consciousness of patients disappeared, 10 μg·kg^-1 alfentanil and 0.2 mg·kg^-1 cisatracurium besilate were used for anesthesia induction, and 0.3-1.0 mg·kg^-1·h^-1 remimazolam+ 0.1 μg·kg^-1·min^-1 remifentanil + 0.2 mg·kg^-1·h^-1 cisatracurium besilate were applied for anesthesia maintenance. The anesthetic effect, heart rate (HR) and mean arterial pressure (MAP) during recovery period, oxidative stress indexes at different time points and, remimazolam remedy were compared among the three groups, and the safety was evaluated.

There were 27 cases in low-dose group, 28 cases in middle-dose group and 25 cases in high-dose group. The HR values at extubation in low-dose group, middle-dose group and high-dose group were (79.47±6.85), (75.84±6.71) and (72.03±5.79) beat·min^-1, HR values at 5 min after extubation were (81.92±6.59), (78.09±7.03) and (74.17±7.26) beat·min^-1, serum superoxide dismutase (SOD) levels at 24 h after surgery were (87.61±11.25), (95.49±14.02) and (103.86±15.37) U·mL^-1, serum malondialdehyde (MDA) levels were (19.69±2.74), (17.24±2.45) and (15.08±2.29) mmol·L^-1, serum catalase (CAT) levels were (66.75±8.39), (71.69±8.55) and (76.91±9.13) U·mL^-1, the onset time of sedation was (94.36±4.42), (82.29±4.15) and (75.17±5.38) s, respectively, and there were significant differences between any two groups of the three groups (all P<0.05). There were 4 cases (14.81%), 0 case and 0 case of remimazolam remedy in low-dose group, middle-dose group and high-dose group, respectively, and the index in middle-dose group and high-dose group was significantly different compared with that in low-dose group (P<0.05). In the low-dose group, there was 1 case (3.70%) of hypotension, 1 case (3.70%) of respiratory depression, and 2 cases (7.41%) of intraoperative body movement. In the middle-dose group, there was 1 case (3.70%) of hypotension, 1 case (3.57%) of bradycardia, and 1 case (3.70%) of respiratory depression. In the high-dose group, there was 1 case (4.00%) of hypotension, 2 cases (8.00%) of bradycardia, and 2 cases (8.00%) of respiratory depression. There was no statistically significant difference in the incidence of adverse drug reactions among the three groups (all P>0.05).

The induction of general anesthesia with different doses of remimazolam has a certain application effect in the vascular interventional treatment of intracranial aneurysms, and the induction of general anesthesia with high doses of remimazolam (0.4 mg·kg^-1) is the most ideal. It is not only beneficial to maintaining the stability of hemodynamics during the recovery period, and alleviating the oxidative stress response, but also shortening the onset time of sedation, reduce the number of remedial cases, and it has good safety.