Key result
Remimazolam anesthesia resulted in a similar maximum decrease in mean arterial pressure compared to propofol (39.2 vs 43.8 mmHg; p=0.443), but a 6 mg/kg/h induction dose reduced vasoactive drug use.
Why the study?
Remimazolam offers hemodynamic stability and rapid onset, but the effects of different induction doses compared to propofol on hemodynamics and recovery in older patients required investigation.
Does remimazolam anesthesia improve hemodynamic stability compared to propofol anesthesia in older patients?
RCT (n=69)
randomly assigned
Does remimazolam anesthesia improve hemodynamic stability compared to propofol anesthesia in older patients?
Absolute Event Rate: 39.2% vs 43.8%
p-value: p=0.443
Remimazolam anesthesia with an induction dose of 6 mg/kg/h reduces the requirement for vasoactive drugs compared to propofol anesthesia in older patients.
Remimazolam dosing in older patients remains unclear; leaves open optimal regimen versus propofol for hemodynamics.
Remimazolam has advantages such as hemodynamic stability and rapid onset. We investigated the effects of induction doses on hemodynamics and recovery profiles for remimazolam compared to propofol in older patients. Sixty-nine patients aged >65 years were randomly assigned to either the propofol anesthesia group (P group) or the remimazolam anesthesia group with an induction dose of 6 mg/kg/h (R6 group) or 12 mg/kg/h (R12 group), followed by 1 mg/kg/h. P group was anesthetized with 4 µg/mL of propofol effect-site concentration (Ce) with target-control infusion, followed by 2.5–3 µg/mL of Ce. The primary outcome was the difference between the baseline mean arterial pressure (MAP) and the lowest MAP during anesthesia (ΔMAP). ΔMAP was comparable between the P, R6, and R12 groups (43.8 ± 13.8 mmHg, 39.2 ± 14.3 mmHg, and 39.2 ± 13.5 mmHg, p = 0.443). However, the frequencies of vasoactive drug use were 54.5%, 17.4%, and 30.4% (p = 0.029), and the median doses of ephedrine 3 (0–6) mg, 0 (0–0) mg, and 0 (0–0) mg (p = 0.034), which were significantly different. This study showed remimazolam anesthesia with an induction dose of 6 mg/kg/h, rather than 12 mg/kg/h, could reduce the requirement for vasoactive drugs compared to propofol anesthesia.
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Kim et al. (2023) conducted an RCT in Anesthesia in older patients (n=69). Remimazolam vs. Propofol was evaluated on Difference between baseline mean arterial pressure (MAP) and lowest MAP during anesthesia (ΔMAP) (p=0.443). Remimazolam anesthesia resulted in a similar maximum decrease in mean arterial pressure compared to propofol (39.2 vs 43.8 mmHg; p=0.443), but a 6 mg/kg/h induction dose reduced vasoactive drug use.
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