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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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| remimazolam based MAC group | Experimental | remimazolam based monitored anesthesia care |
|
| inhalation general anesthesia group | Active Comparator | general anesthesia with sevoflurane |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| remimazolam based MAC | Drug | The surgery will be performed under monitored anesthesia care by maintaining spontaneous breathing using remimazolam. |
|
| Measure | Description | Time Frame |
|---|---|---|
| anesthesia time excluding operation time | anesthesia time excluding operation time | 0-1 hour after the end of surgery (Time point at which patient exit the operating room) |
| Measure | Description | Time Frame |
|---|---|---|
| surgery cost and anesthesia cost | surgery cost and anesthesia cost: insured cost and non-insured cost | 1 month after surgery |
| surgeon's satisfaction score | surgeon's satisfaction score: very poor (1)/ poor (2)/ satisfactory (3)/ good (4)/excellent (5) |
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Inclusion Criteria:
patients undergoing transurethral bladder resection
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Jin Ha Park | Contact | 82-2-2228-2420 | realsummer@yuhs.ac |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Yonsei university college of medicine | Seoul | South Korea |
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| general anesthesia with sevoflurane | Drug | The surgery will be performed under mechanical ventilation with inhalation general anesthesia |
|
| At the end of surgery |
| patient's satisfaction score | patient's satisfaction score: very poor (1)/ poor (2)/ satisfactory (3)/ good (4)/excellent (5) | 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. | 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. | 0-2 hour after surgery (Time points at patient discharge from recovery room), and 6 hour after surgery |
| incidence of hypotension | hypotension: baseline BP reduction (20%) | At the end of surgery |
| incidence of hypoxemia | hypoxemia : unresponsive to a jaw thrust maneuver and SPO2 <92% | At the end of surgery |
| ID | Term |
|---|---|
| D000768 | Anesthesia, General |
| D000077149 | Sevoflurane |
| ID | Term |
|---|---|
| D000758 | Anesthesia |
| D000760 | Anesthesia and Analgesia |
| D008738 | Methyl Ethers |
| D004987 | Ethers |
| D009930 | Organic Chemicals |
| D006845 | Hydrocarbons, Fluorinated |
| D006846 | Hydrocarbons, Halogenated |
| D006838 | Hydrocarbons |
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