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January 9, 2023BMC AnesthesiologyOpen Access

Remimazolam did not significantly differ from target-controlled propofol in the maximum decrease of mean arterial pressure during induction of general anesthesia (mean difference 1.7 mmHg, p=0.613).

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Why the study?

Remimazolam confers a lower risk of hypotension than propofol, but no studies have compared the efficacy of remimazolam and propofol administered using target-controlled infusion.

Does remimazolam improve hemodynamic stability compared to target-controlled propofol during induction of anesthesia in middle-aged and elderly adults?

Population

Forty adults aged 45-80 years with ASA Physical Status 1-2

Comparison

Remimazolam (12 mg/kg/h) vs propofol (3 μg/mL, TCI) with remifentanil

Design

Single-center randomized controlled trial

Key result

Remimazolam did not significantly differ from target-controlled propofol in the maximum decrease of mean arterial pressure during induction of general anesthesia (mean difference 1.7 mmHg, p=0.613).

Authors

RSRyo SekiguchiMKMichiko KinoshitaRKRyosuke Kawanishi

Discussion

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Overview

Remimazolam shows no hemodynamic edge over TCI propofol here; leaves open whether larger trials would detect differences in hypotension risk.

Study Design

Type

RCT (n=40)

Blinding

Single-blind

Randomization

Sealed envelope system

Multicenter

No

Structured PICO

Does remimazolam improve hemodynamic stability compared to target-controlled propofol during induction of anesthesia in middle-aged and elderly adults?

P
Population
40 middle-aged and elderly adults (aged 45-80 years) undergoing surgery under general anesthesia, followed from induction to 10 minutes after endotracheal intubation.
I
Intervention
Remimazolam (12 mg/kg/h) along with remifentanil for inducing anesthesia
C
Comparator
Propofol (3 μg/mL, target-controlled infusion) along with remifentanil for inducing anesthesia
O
Outcome
Maximum change in mean arterial pressure (MAP) after inductionsurrogate

Main Result

Mean Difference: 1.7 (95% CI -8.2–4.9)

Absolute Event Rate: -41.1% vs -42.8%

p-value: p=0.613

Remimazolam and target-controlled propofol result in similar hemodynamic changes during the induction of general anesthesia in middle-aged and elderly patients.

Limitations

  • Non-invasive blood pressure was measured every 2.5 min instead of continuous arterial blood pressure.
  • Ephedrine was administered to treat persistent hypotension for safety reasons.
  • TCI system was used for propofol but not remimazolam.
  • esCCO was used to estimate CO and SV, which may differ from actual values.
  • Observation period was limited to 10 min after endotracheal intubation.

Cite This Study

Sekiguchi et al. (2023) conducted an RCT in General anesthesia induction (n=40). Remimazolam vs. Target-controlled propofol (3 μg/mL) was evaluated on Maximum change in mean arterial pressure (MAP) after induction (MD 1.7, 95% CI -8.2 to 4.9, p=0.613). Remimazolam did not significantly differ from target-controlled propofol in the maximum decrease of mean arterial pressure during induction of general anesthesia (mean difference 1.7 mmHg, p=0.613).

synapsesocial.com/papers/6a5ac7223c250e58fd489c8fhttps://doi.org/10.1186/s12871-023-01974-9
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Comparison of hemodynamics during induction of general anesthesia with remimazolam and target-controlled propofol in middle-aged and elderly patients: A single-center, randomized, controlled trial2022 · 5 citations
  2. 2Effect of remimazolam vs. propofol on hemodynamics during general anesthesia induction in elderly patients: Single-center, randomized controlled trial2023 · 16 citations
  3. 3Comparison of remimazolam and propofol induction on hemodynamic response in hypertensive patients2023 · 22 citations
  4. 4Comparison of Remimazolam and Propofol on Post-Induction Hypotension in Elderly Hypertensive Patients: A Randomized Controlled Trial2025 · 7 citations
  5. 5Hypotension after General Anesthesia Induction with Remimazolam or Propofol in Geriatric Patients Undergoing Sevoflurane Anesthesia with Remifentanil2025