Interventions
muscular paralysis, loss of consciousness, hypotension
BLOOD, SINUS BRADYCARDIA
General anesthesia was induced with RT (0.3 mg/kg, iv) (Jiangsu Hengrui Medicine Co, Ltd, Jiangsu, China) or propofol (2.0–2.5 mg/kg, iv) (AstraZeneca, United Kingdom) in combination with sufentanil (0.2–0.4 µg/kg, iv). If loss of consciousness (LoC) did not occur within 3 min, an IV dose of RT (0.1 mg/kg) or propofol (1.0 mg/kg) was administered. After LoC was confirmed, muscular paralysis was achieved using rocuronium (0.2–0.4 mg/kg, iv) and an LMA was inserted.RT was maintained at 1–3 mg/kg/h and propofol was maintained within a range of 6–12 mg/kg/h. Remifentanil was administered at an infusion rate of 0.05–0.15 µg/kg/min. Bispectral index (BIS) was used to evaluate anesthesia depth. IV anesthetic infusion was discontinued when the final surgical dressing was applied. The participant who developed hypotension, defined as systolic blood pressure (SBP) < 80% of baseline, was administered a bolus dose of 6 mg ephedrine or 0.1 mg phenylephrine that was repeated as necessary. Sinus bradycardia, defined as a heart rate (HR) below 40 beats/min, was treated with 0.5 mg of atropine.Towards the end of the surgery, nalmefene (20 µg, iv), neostigmine (0.04 mg/kg, iv) and atropine (0.02 mg/kg, iv) were allowed to be administered as necessary. In the RT + flumazenil group, 0.2 mg flumazenil (Zhejiang Aotuokang Medicine Co, Ltd, Zhejiang, China) was administered 10 min after the discontinuation of RT. If necessary, a repeated dose of 0.1 mg flumazenil was permitted every minute until the total dose reached 1 mg. Blood pressure, HR, blood oxygen saturation (SpO