Background/Objectives: Transurethral resection of bladder tumor (TURBT) is commonly performed in elderly patients and often requires repeated procedures. A high proportion of non-procedural time in TURBT affects operating room utilization, highlighting the need for a safe and efficient anesthesia method. This study aimed to compare remimazolam-based monitored anesthesia care (MAC) guided by analgesia nociception index (ANI) monitoring to inhalation-based general anesthesia (GA) for TURBT, focusing on induction and emergence time (IAET). Methods: Forty-six patients who underwent TURBT were randomly assigned into either the MAC group or GA group. The primary outcome was the IAET. The secondary outcomes included hospital and anesthesia charges, safety (intraoperative hypotension and desaturation), and feasibility (surgeon and patient satisfaction) of both anesthetic methods. Results: The MAC group demonstrated a significantly shorter IAET (14 vs. 25 min,p< 0.001) and lower anesthesia cost (USD 152 vs. USD 195,p< 0.001). The MAC group showed better hemodynamic stability with a lower incidence of hypotension (29% vs. 73%,p= 0.004). Seven patients (33%) in the MAC group experienced intraoperative desaturation; all patients recovered without complications through the jaw-thrust maneuver. Patient satisfaction was equally high in both groups, and surgeon satisfaction, though slightly lower with MAC (71% vs. 100% rating “excellent”,p= 0.009), remained acceptable. Conclusions: Remimazolam-based MAC, guided by ANI monitoring, offers significant advantages including shorter IAET, reduced costs, and improved safety for TURBT, particularly in patients with small tumors. These findings support MAC as a promising alternative to GA for TURBT, as it enhances perioperative outcomes and operating room efficiency.
背景/目的：经尿道膀胱肿瘤切除术（TURBT）在老年患者中普遍实施，且常需重复进行。TURBT中非手术时间占比较高，影响手术室利用率，凸显了对安全高效麻醉方法的需求。本研究旨在比较基于瑞马唑仑、以镇痛伤害指数（ANI）监测为导向的监测麻醉管理（MAC）与吸入式全身麻醉（GA）在TURBT中的应用，重点关注诱导与苏醒时间（IAET）。方法：将46例接受TURBT的患者随机分为MAC组或GA组。主要观察指标为IAET。次要观察指标包括两种麻醉方法的医院及麻醉费用、安全性（术中低血压和血氧饱和度下降）及可行性（外科医生和患者满意度）。结果：MAC组表现出显著更短的IAET（14分钟 vs. 25分钟，p<0.001）和更低的麻醉费用（152美元 vs. 195美元，p<0.001）。MAC组血流动力学稳定性更佳，低血压发生率更低（29% vs. 73%，p=0.004）。MAC组有7例患者（33%）出现术中血氧饱和度下降；所有患者均通过托颌手法恢复，无并发症发生。两组患者满意度均较高，外科医生满意度虽在MAC组略低（71% vs. 100%评为“优秀”，p=0.009），但仍处于可接受水平。结论：基于瑞马唑仑、以ANI监测为导向的MAC在TURBT中具有显著优势，包括更短的IAET、更低的费用以及更高的安全性，尤其适用于肿瘤较小的患者。这些发现支持MAC作为TURBT中GA的一种有前景的替代方案，可改善围手术期结局并提高手术室效率。
肿瘤(癌症)患者之家