What is the clinical evidence from this study?

Study design: RCT. Population: Patients undergoing fiberoptic bronchoscopy (n=232). Intervention: Remimazolam besylate vs. Propofol. Primary outcome: Incidence of hypotension during induction (RR 2.59, 95% CI 1.88-3.56, p=<0.001).

What question did this study set out to answer?

To compare the hemodynamic profiles of remimazolam besylate and propofol in elderly patients during bronchoscopy under general anesthesia.

June 14, 2026BMC Anesthesiology0 citationsOpen Access

Efficacy of remimazolam besylate versus propofol on hemodynamics during anesthetic induction in elderly patients undergoing bronchoscopy: a randomized controlled trial

Q: What are the key findings of this study?

Remimazolam besylate significantly reduced the incidence of hypotension during anesthetic induction compared to propofol (28.44% vs. 73.33%, RR 2.59) in elderly patients undergoing bronchoscopy.

Q: What does this research mean for the field?

Remimazolam besylate significantly reduces the incidence of hypotension during anesthetic induction compared to propofol in elderly patients undergoing bronchoscopy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To compare the hemodynamic profiles of remimazolam besylate and propofol in elderly patients during bronchoscopy under general anesthesia.

DLDanni LiUniversity of Electronic Science and Technology of China CYCheng YangShandong Agricultural University YZYuanYuan ZhouUniversity of Electronic Science and Technology of China

Key Result

Remimazolam besylate significantly reduced the incidence of hypotension during anesthetic induction compared to propofol (28.44% vs. 73.33%, RR 2.59) in elderly patients undergoing bronchoscopy.

Key Points

To compare the hemodynamic profiles of remimazolam besylate and propofol in elderly patients during bronchoscopy under general anesthesia.
Randomly assigned 232 patients aged ≥ 65 years to receive either remimazolam besylate or propofol for sedation during bronchoscopy.
Monitored vital signs and bispectral index (BIS) throughout the procedure.
Assessed the incidence of hypotension and other intraoperative outcomes.
Remimazolam besylate group had a lower incidence of hypotension: 28.44% vs. 73.33%, 95% CI 1.88–3.56, P < 0.001.
Mean arterial pressure variability was significantly lower in the remimazolam group (8.25 mmHg/min) compared to propofol (12.33 mmHg/min), P < 0.001.
Optimal induction dose of remimazolam besylate was determined to be 0.16 mg/kg.

Study Design

Type

RCT (n=232)

Blinding

Double-blind

Randomization

1:1 computer-generated random sequence

Multicenter

Structured PICO

Does remimazolam besylate reduce the incidence of hypotension during induction compared to propofol in elderly patients undergoing bronchoscopy?

Population

232 elderly patients aged 65-80 years scheduled for fiberoptic bronchoscopy under general anesthesia.

Intervention

Remimazolam besylate (initial bolus 0.1 mg/kg, additional 0.05 mg/kg until loss of consciousness, maintenance 1 mg/kg/h) combined with remifentanil.

Comparator

Propofol (initial bolus 1 mg/kg, additional 0.5 mg/kg until loss of consciousness, maintenance 6 mg/kg/h) combined with remifentanil.

Outcome

Incidence of hypotension during induction (defined as a decrease of mean arterial pressure of ≥30% from baseline).safety

In elderly patients undergoing bronchoscopy, remimazolam besylate significantly reduces the incidence of hypotension and provides better hemodynamic stability during anesthetic induction compared to propofol.

Main Result

Relative Risk: 2.59 (95% CI 1.88–3.56)

Absolute Event Rate: 28.44% vs 73.33%

p-value: p=<0.001

Abstract

The effect of remimazolam besylate versus propofol on hemodynamics during bronchoscopy remains uncertain. To test the hypothesis that remimazolam besylate can provide a more stable hemodynamic profile than propofol in the elderly for bronchoscopy under general anesthesia and calculate the optimal induction doses. A total of 232 patients aged ≥ 65 years who underwent bronchoscopy were enrolled. Participants were randomly divided into the remimazolam besylate group or propofol group for sedation. The patients received titrated induction with remimazolam besylate or propofol combined with remifentanil and maintenance with assigned agents. Vital signs and bispectral index (BIS) changes were monitored. The cognitive test was performed before and after operation. The primary outcome was the incidence of hypotension during induction. Secondary key outcomes included average real variability of mean arterial pressure, titrated dose of remimazolam besylate and propofol during induction, and the BIS changes. Other outcomes included baseline characteristics, intraoperative anesthesia-related data, and other adverse events. The remimazolam besylate group had a significantly lower incidence of hypotension during anesthetic induction (28.44% vs. 73.33%,95% CI 1.88–3.56, P < 0.001). The average real variability of mean arterial pressure of remimazolam besylate group was 8.25 ((Interquartile range IQR 6.33–11.50) mmHg/min smaller than that 12.33 (IQR 9.00–14.67) mmHg/min in propofol group ( P < 0.001). The optimal dose of remimazolam besylate by titration during induction was 0.16 (IQR 0.15–0.18) mg/kg. The mean BIS values in remimazolam besylate group was higher than that in propofol group 59.35 (IQR 53.15–65.11) vs. 55.13 (IQR 51.72–61.75), P < 0.001. Remimazolam besylate was superior to propofol in terms of hemodynamics for the elderly undergoing bronchoscopy. Furthermore, we proposed a titrated dose of remimazolam besylate 0.16 mg/kg during induction in this patient population.

Ask AI

Helpful

Bookmark

View Full Paper