Effects of Different Doses of Rimazolam on Oxidative Stress Level Sedation Score and Recovery Time of Patients during Hip Replacement.

The effects of Rimazolam on oxidative stress level, sedation score, and recovery time of patients under different doses in hip replacement are investigated. A total of 100 patients who underwent hip arthroplasty in our hospital from September 2020 to May 2022 are selected as the study subjects. According to the random number table method, they are divided into observation group and control group. The observation group is given 0.3 mg/kg Rimazolam, and the control group is given 0.4 mg/kg Rimazolam. Oxidative stress level, hemodynamic indexes at different time after anesthesia, sedation score and sedation depth, Visual Analogue Scale/Score (VAS) score and incidence of adverse reactions are observed in 2 groups. The correlation of sedation score with oxidative stress index and pain degree is analyzed. The experimental results show that Rimazolam has a good anesthesia induction effect in hip replacement, but the low dose (0.3 mg/kg) can reduce the level of oxidative stress in patients, has a better sedation effect and can maintain the stability of patients' hemodynamic indicators, and has a positive effect on relieving postoperative pain in patients. [Clinical Trial Registration Number- ChiCTR2000038548].

1. Introduction

With the continuous development of society and the continuous progress of science and technology, the aging of population is becoming more and more serious. The elderly are more prone to fall and knock against, resulting in fracture due to the deterioration of various bodily functions, sluggish reaction, and discoordination of limbs [1, 2]. Hip femur fracture is a common disease type in elderly patients with fracture, which seriously affects the independent living ability and quality of life of elderly patients [3]. Hip replacement is a golden scheme for the treatment of this kind of disease in elderly patients, and its mechanism is mainly to replace the damaged hip joint with artificial joint, which has been widely used in clinical practice [4, 5]. Hip replacement often requires general anesthesia to better maintain intraoperative circulation and reduce patient stress responses. However, this type of anesthesia is limited by personal tolerance, and some patients will suffer a series of adverse reactions such as respiratory abnormalities, circulation instability, and affecting the prognosis of patients [6]. An important process of general anesthesia is anesthesia induction, which can well alleviate some adverse reactions in general anesthesia and maintain the stability of hemodynamic indicators of patients [7].

Rimazolam is a new benzodiazepine designer. This drug is characterized by quick effect, quick recovery and small influence, and can exert sedative effect quickly [8]. However, the quality of anesthesia induction with different doses of Rimazolam is not uniform, so the selection of appropriate drug dose can greatly improve the stability of circulation in patients during surgery and reduce adverse reactions [9]. At this stage, high dose hip replacement in the elderly is clinically appropriate. In this study, different doses are used to explore its application in elderly hip replacement, and its effects on oxidative stress level, sedation score, and recovery time in patients.

The rest of this paper is organized as follows: Section 2 discusses related work, followed by case description, and the proposed methods designed in Section 3. Section 4 shows the experimental results and analysis, and Section 5 is the conclusion and relevant appraisement for the whole study.

2. Related Works

With the increase of age, the physical fitness of the elderly gradually decreases. If there is a fall, violence, or accident, it is very likely to cause femur fracture, affecting the daily activities and quality of life of the patient, and even paralysis in serious cases [10]. Hip replacement, as the main surgical method for the treatment of such diseases, has high clinical efficacy, and about 85% of patients can recover to the best fracture after surgery [11, 12]. Hip replacement is a process of replacing the injured part with an artificial prosthesis, which has a strong pain sensation. Therefore, the patient is usually under general anesthesia before the operation [13]. At the same time, the use of Rimazolam in general anesthesia can effectively induce anesthesia, strengthen the sedation effect. However, the choice of dosage of the drug needs to be careful, too low dose cannot effectively play a sedative effect and affect the patient's nervous system. Too high a dose will affect the patient's respiratory and circulatory system. They can lead to a poor prognosis, so it is very important to select and actual amount of Rimazolam for induction.

In this study, 0.3 mg/kg and 0.4 mg/kg Rimazolam were used to explore the different effects of different doses of Rimazolam on induction of general anesthesia during hip replacement. The results showed that oxidative stress level in the observation group was significantly lower than that in the control group, and the range of hemodynamic indexes in the observation group was significantly smaller than that in the control group. The difference was statistically significant (P < 0.05), which was consistent with the research results of Chen et al. [14]. The results of the study showed that the appropriate dose of anesthesia inducer can stabilize the hemodynamic changes of patients. Analysis of its mechanism is as follows: Rimazolam has the characteristics of high efficiency and fast, which can anesthesia patients in a short time, reduce the waiting process, thus relieving patients' psychological fear, tension, and anxiety, and greatly reducing the level of oxidative stress of patients. At the same time, low dose Rimazolam can reduce the burden of patients' respiratory and circulatory system and ensure the stability of patients' hemodynamic indicators. Meanwhile, the results of this study showed that the sedation score, recovery time, extubation time, and Postanesthesia Care Unit (PACU) retention time in the observation group were all lower with statistically significant differences (P < 0.05). It is consistent with the research results of He [15], who showed that low-dose anesthesia inducers can accelerate the recovery time and extubation time of patients, and accelerate the recovery of patients. Analysis of its mechanism is as follows: Rimazolam has a quick sedative effect and good effect. Meanwhile, the low-dose drug will not affect the patient's respiratory circulation while effectively sedating, so that the patient can wake up as soon as possible, accelerates the extubation time of the patient and reduce the PACU residence time.

Some studies have shown that the application of anesthetic sedatives during hip replacement in the elderly can effectively relieve pain [16], which is consistent with the results of this study. The results of this study showed that the pain score of the observation group decreased significantly than the control group, and the incidence of total adverse reactions was also significantly lower with statistical significance (P < 0.05). It is suggested that strict control of the dosage of Rimazolam cannot only effectively affect sedation, but also reduce the adverse reactions of patients, it has high safety. Analysis of its mechanism may be as follows: hip replacement has a high degree of pain, and the pain is likely to cause stress response of patients, resulting in accelerated heart rate and increased blood pressure, which will increase patients' tension and anxiety, and is not conducive to follow-up recovery. Appropriate dose of remazolam can reduce neuroendocrine reaction, thus it can effectively keep sedation, and relieve pain. At the same time, it has little impact on the patient's respiratory and circulatory system, which can reduce the occurrence of hypotension and hypoxemia in patients, and the adverse reactions in the process of anesthesia are mild, and can be recovered after simple treatment, with high safety. In addition, the results of this study showed that patients' sedation score was closely related to their oxidative stress index and pain degree, which may be caused by the drug to further improve sympathetic nerve excitation activity and reduce neuroendocrine reaction, thus achieving sedation effect and effectively improving patients' postoperative pain symptoms. It is further confirmed that the sedation effect has an important influence on the recovery of the patient's body state and the effective control of postoperative pain.

3. Cases' Description and the Proposed Methods

3.1. Cases' Description

A total of 100 patients who underwent hip arthroplasty in our hospital from September 2020 to May 2022 are selected as the research objects and divided into observation group and control group according to random number table method. There are 54 patients in the observation group, including 26 males and 28 females. The average age is (67.39 ± 4.23) years. Intertrochanteric fracture of femur in 23 cases, femoral neck fracture in 31 cases, 32 cases of fall injury, 13 cases of traffic accident, 9 cases of falling injury. According to the American College of Anesthesiologists (ASA) [17], 15 cases are classified as grade I, 31 as grade II, and 8 as grade III. There are 46 patients in the control group, including 25 males and 21 females. The average age is (67.96 ± 3.42) years. Intertrochanteric fracture of femur in 20 cases, femoral neck fracture in 26 cases, 29 cases of fall injury, 10 cases of traffic accident, 7 cases of falling injury. According to the American Society of Anesthesiologists (ASA) classification, 12 cases are grade I, 28 cases are grade II, and 6 cases are grade III. There is no significant difference in general data between the two groups (P > 0.05).

Inclusion criteria are as follows: (1) meet the diagnostic criteria for femoral fracture [18]; (2) age ≥ 60; (3) all vital signs are stable; (4) no other malignant diseases; (5) volunteer to participate in this study; (6) informed consent is signed by patients and their families. Exclusion criteria are as follows: (1) patients who do not meet the above inclusion criteria; (2) patients with severely impaired liver and kidney function; (3) patients with cognitive and behavioral disorders who cannot communicate normally; (4) patients with a history of drug allergy; (5) patients with multiple systemic fractures; (6) patients unable to participate in the whole study.

3.2. The Proposed Methods

Patients in both groups underwent the same general anesthesia, and hemodynamic indexes of patients in both groups are detected at all times during surgery. The hemodynamic indexes are as follows: Arterial Oxygen Saturation (SaO2), Mean Arterial Pressure (MAP), and Heart Rate (HR). The observation group is given a low dose of Rimazolam, 0.3 mg/kg Rimazolam intravenous injection for anesthesia induction, 2 min later, 0.3 μg/kg sufentanil, specification: 1 ml: 50 μg; 0.6 mg/kg rocuronium, specification: 2.5 ml: 25 mg; Plasma target controlled injection of 1.5-3.0 μg/ml propofol and 0.2-0.4 μg/(kg·min) remifentanil are used for anesthesia maintenance. Specifications: 20 ml: 200 mg and 1 mg, respectively. Continue until the surgery is complete. The control group is given a high dose of Rimazolam, 0.4 mg/kg Rimazolam intravenously for anesthesia induction, and other anesthesia methods are consistent with the control group.

3.3. Observation Indicators

There are eight observation indicators as follows:

(1) Methods peripheral venous blood is collected 1 day before surgery and 2 days after surgery, and the levels of Nitric Oxide (NO) and Andadrenocorticotropic Hormone (ACTH) are determined. The detection method is Enzyme Linked Immunosorbent Assay (ELISA), and the double-antigen sandwich method is used for detection. The 50 ml concentrated washing solution is diluted to 1000 ml with deionized water and stored in a special lotion bottle. The HRP-conjugate reagent is placed in a specified position for absorbance value observation, and the critical value is as follows: average absorbance value of negative control × 2.1. The kit is selected from Qingdao Hantang Biotechnology Co., LTD. Operated by professional physicians in accordance with the instructions; (2) hemodynamic indexes of patients at different time after anesthesia are observed, including SaO2, MAP, and HR indexes before anesthesia induction (T0) and 30 min after anesthesia induction (T30 min); (3) the sedation score of patients is observed, and the sedation evaluation is conducted according to the Ramsay Sedation Score (RSS) [19]. RSS has 5 grades are as follows: Level 1: the patient's consciousness is 0, and the patient has no response to pat call, and will respond to injurious stimuli. Level 2: the patient's consciousness is not completely lost, with slight fuzzy consciousness and no response to loud calls; Level 3: blurred consciousness, responding to the call to beat; Level 4: slightly clear consciousness, clear response when tapping and calling; Level 5: conscious and able to respond to medical staff's questions. (4) The sedation depth of patients is observed, including the time of eye opening, Bispectral index (BIS), extubation time, and the stay time of PACU. (5) VAS scores at different time are observed;.(6) The incidence of adverse reactions (nausea and vomiting, hypotension, hypoxemia, etc.) are observed. (7) The correlation between sedation score and stress index of patients undergoing hip replacement is analyzed. (8) The correlation between sedation score and pain degree of patients undergoing hip replacement is analyzed.

3.4. Statistical Methods

In this study, all data, and establish a corresponding database, data processing all database entry SPSS 26.0, the bank of China, including measurement data line the normal inspection, representation of (), data using independent sample t test, count data using percentage (%), said by x2 said, repeated measurement ANOVA is used for comparison at various time periods, and spherical test is performed. The correlation between sedation score and stress index and pain degree of patients undergoing hip replacement is completed by Pearson correlation coefficient analysis. P < 0.05, the difference is statistically significant.

4. Experimental Results

4.1. Comparison of Oxidative Stress Levels

Table 1 shows the comparison of oxidative stress levels. In Table 1, “∗” means the preoperative comparison with this group, ∗P < 0.05 means the difference is statistically significant. It can be seen from Table 1 that the NO and ACTH levels are not significantly different 1 d before surgery (P > 0.05). The levels of NO and ACTH in the observation group are decreased significantly than the control group 2 d after surgery, and the level of 2 d NO is increased from 1 d before surgery, while the level of ACTH is decreased from 1 d before surgery (P < 0.05).

Table 1

Comparison of oxidative stress levels ().

Group	The number of cases	NO (μmol/mL)		ACTH (pg/mL)
		1 d before surgery	2 d after the operation	1 d before surgery	2 d after the operation
Observation group	54	439.13 ± 89.60	199.11 ± 22.58∗	30.68 ± 2.60	36.76 ± 8.22∗
The control group	46	440.48 ± 79.83	254.50 ± 31.07∗	30.18 ± 3.05	43.68 ± 7.59∗
t		0.079	10.295	0.885	4.345
P		0.937	<0.01	0.378	<0.01

4.2. Comparison of Hemodynamic Indexes at Different Time after Anesthesia

Table 2 shows the comparison of hemodynamic indexes at different times after anesthesia of patients. In Table 2, “∗” means that compared with T0 of this group, ∗P < 0.05 means that the difference is statistically significant. It can be seen from Table 2 that there is no significant difference in hemodynamic indexes at T0 (P > 0.05). SaO2 and HR indexes T30 min in observation group are significantly increased compared with T0, and MAP indexes are significantly decreased, while SaO2 and MAP indexes T30 min in control group are significantly decreased, and HR indexes are significantly increased, the differences are statistically significant (P < 0.05). The T30 min SaO2 and MAP indexes in observation group are increased significantly than the control group, while HR indexes are decreased significantly than that in control group (P < 0.05).

Table 2

Comparison of hemodynamic indexes at different times after anesthesia of patients ().

Group	The number of cases	SaO2 (%)		HR (min)		MAP (mmHg)
		T0	T30 min	T0	T30 min	T0	T30 min
Observation group	54	97.69 ± 1.91	100.35 ± 3.00∗	68.09 ± 5.34	70.31 ± 3.09∗	95.03 ± 5.30	88.28 ± 4.66∗
The control group	46	97.38 ± 1.91	87.29 ± 2.63∗	67.96 ± 5.10	74.93 ± 4.82∗	95.33 ± 5.65	82.54 ± 5.02∗
t	—	0.809	22.951	0.124	5.787	0.274	5.925
P	—	0.421	<0.01	0.902	<0.01	0.785	<0.01

4.3. Comparison of Sedation Scores

Table 3 shows the comparison of sedation scores of patients. It can be seen from Table 3 that the RSS score of the observation group is (1.36 ± 0.25) points, and that of the control group is (2.61 ± 0.57) points. The sedation score of the observation group are decreased significantly than the control group, and the difference is statistically significant (P < 0.05).

Table 3

Comparison of sedation scores of patients ().

Group	The number of cases	RSS (score)
Observation group	54	1.56 ± 0.50
The control group	46	3.15 ± 0.82
t		11.893
P		<0.01

4.4. Comparison of the Depth of Sedation

Table 4 shows the comparison of the depth of sedation of patients. It can be seen from Table 4 that there is no significant difference in BIS (P > 0.05). Meanwhile, the awakening time, extubation time, and PACU residence time in observation group are decreased significantly than the control group (P < 0.05).

Table 4

Comparison of the depth of sedation of patients ().

Group	The number of cases	Wake up of time (min)	The BIS when they wake up	Extubation time (min)	PACU residence time (min)
Observation group	54	6.67 ± 1.61	90.56 ± 2.37	12.83 ± 1.71	35.63 ± 5.63
The control group	46	13.37 ± 2.63	90.30 ± 2.62	23.83 ± 3.23	54.21 ± 6.90
t		15.607	0.521	21.719	14.827
P		<0.01	0.604	<0.01	<0.01

4.5. Comparison of the VAS Scores at Different Time

Table 5 shows the comparison of the VAS scores of patients at different times. Figure 1 shows the VAS scores of patients at different times. It can be seen from Table 4 and Figure 1 that repeated measure an OVA show that VAS scores are decreased gradually over time (P < 0.05), and VAS scores at 3 h, 6 h, and 8 h in the observation group are lower with statistically significant differences (P < 0.05).

Table 5

Comparison of the VAS scores of patients at different times ().

Group	Point in time	VAS (score)
Observation group(n = 54)	3 h	2.69 ± 1.15
	6 h	2.11 ± 0.79
	8 h	1.52 ± 0.50
The control group(n = 46)	3 h	3.37 ± 1.08
	6 h	2.56 ± 0.50
	8 h	2.09 ± 0.69
F point		124.32
P point		<0.001
F Time ∗ group		131.87
P Time ∗ group		<0.001

Figure 1

VAS scores of patients at different times.

4.6. Comparison of the Incidence of Adverse Reactions

Table 6 shows the comparison of the incidence of adverse reactions. It can be seen from Table 6 that 1 patient presents nausea and vomiting, 3 patients present hypotension, and 2 patients present hypoxemia, and the total incidence of adverse reactions is 11.11% in the observation group. In the control group, there are 3 cases of nausea and vomiting, 5 cases of hypotension, and 4 cases of hypoxemia, and the total incidence of adverse reactions is 26.09%. The incidence of ADR in observation group are decreased significantly than the control group, and the difference is statistically significant (P < 0.05).

Table 6

Comparison of the incidence of adverse reactions (n, %).

Group	The number of cases	Nausea and vomiting	Low blood pressure	Hypoxemia	The total incidence
Observation group	54	1 (1.85)	3 (5.56)	2 (3.70)	6 (11.11)
The control group	46	3 (6.52)	5 (10.87)	4 (8.70)	12 (26.09)
x 2		5.443	5.024	6.535	7.824
P		<0.01	<0.01	<0.01	<0.01

4.7. Analysis of the Correlation between Sedation Score and Stress Index of Patients

Figure 2 shows the correlation between RSS score and NO. Figure 3 shows the correlation between RSS score and ACTH. It can be seen from the above experiment results that Pearson correlation coefficient analysis shows that there is a significant positive correlation between RSS score and stress indicators, including NO and ACTH (P < 0.05).

Figure 2

Correlation between RSS score and NO.

Figure 3

Correlation between RSS score and ACTH.

4.8. Analysis of the Correlation between Sedation Score and Pain Degree in Patients

Figure 4 shows the correlation between RSS score and VAS score. It can be seen from Figure 4 that Pearson correlation coefficient analysis shows a significant positive correlation between RSS score and VAS score (P < 0.05).

Figure 4

Correlation between RSS score and VAS score.

5. Conclusion

The effects of remazolam on oxidative stress level, sedation score, and recovery time of patients under different doses in hip replacement are investigated. The anesthesia induction effect of low dose remazolam is better, which can further strengthen the sedation effect, reduce pain, and relieve oxidative stress level of patients. Moreover, it is more safe and worthy of widespread clinical application. But the sample size is less, this study obtained the suitable dosage is only the dose used inside the study, the results may have certain error, can further improve the sample size in the next step research and through molecular mechanism research, the index changes in this study for further reasoning, which provides the more accurate basis for the clinical.