Impact of remimazolam on hemodynamic stability during catheter ablation procedures under general anesthesia

Introduction Stable hemodynamics during catheter ablation procedures are critical, and hypotensive events can interfere with the procedure. Remimazolam, an ultra-short-acting benzodiazepine anesthetic, has minimal unfavorable effects on hemodynamics. However, little is known about its use during ablation under general anesthesia (GA). Purpose The purpose of this study was to evaluate the effect of remimazolam on blood pressure (BP: Systolic BP [SBP]/Diastolic BP [DBP]) at anesthesia induction and on hemodynamic stability during catheter ablation, in comparison with conventional GA using propofol. Methods Consecutive patients who underwent ablation under controlled GA with a Bispectral Index™ (BIS™) of 40-60 were evaluated. The BP drop during anesthesia induction, the incidence of hypotensive events (minimum SBP during GA<90mmHg), the stability of intraoperative BP control (Δ[maximum-minimum] BP during GA), and the amount of noradrenaline required were compared between the remimazolam and conventional propofol groups. Results Eighty-eight patients (average age 78.1, male 42 [47.7%], remimazolam [n=43], propofol [n=45]) were investigated. The table shows the baseline patient characteristics of both groups. The pre-GA BP and heart rate (149.1±24.8 / 78.1±16.9 vs. 155.3±21.0 / 78.3±14.9 mmHg, 80.7±19.3 vs. 81.0±22.9 bpm, remimazolam vs. propofol, P=0.215, 0.954 and 0.786, respectively) did not differ, however, fewer patients were in sinus rhythm at GA induction in remimazolam group (20/43 [46.5%] vs. 26/45 [57.8%], P<0.001). The figure shows a summary of the hemodynamics effects (pre-GA SBP/DBP, SBP/DBP after GA induction, maximum and minimum SBP/DBP during GA) in both groups. Remimazolam patients exhibited a smaller SBP drop at induction (-31.4±18.9 vs. -49.0±25.0 mmHg, P<0.001) and fewer hypotensive events (7 [16.3%] vs. 16 [35.6%], P<0.001). Moreover, they had a smaller ΔMax-min SBP (38.1±14.0 vs. 61.3±29.0 mmHg, P<0.001) and ΔMax-min DBP (19.8±12.9 vs. 32.2±19.8 mmHg, P<0.001) during GA, and required less noradrenaline (121.4±184.0 vs. 464.3±337.4µg, P<0.001). Conclusions This study demonstrated that remimazolam provided favorable hemodynamic stability during catheter ablation in comparison with conventional propofol GA, and has potential to be a standard drug for catheter ablation under GA.