Key result
Remimazolam resulted in a significantly lower mean arterial pressure at tracheal intubation compared to etomidate (83 vs. 108 mmHg; mean difference -26) in the presence of fentanyl.
Why the study?
Combined use of hypnotics and opioids during anesthesia induction decreases blood pressure, and post-induction hypotension is a common side effect. The study aimed to compare mean arterial pressure changes induced by remimazolam versus etomidate in the presence of fentanyl at tracheal intubation.
Does remimazolam reduce mean arterial pressure compared to etomidate during anesthesia induction in adult patients undergoing elective urological surgery?
RCT (n=133)
Single-blind
Computer-generated random numbers
No
Does remimazolam reduce mean arterial pressure compared to etomidate during anesthesia induction in adult patients undergoing elective urological surgery?
Remimazolam induces a lower mean arterial pressure and higher rates of post-induction hypotension compared to etomidate during anesthesia induction with fentanyl.
Anticipate greater vasopressor needs with remimazolam-fentanyl induction; first head-to-head RCT challenges remimazolam hemodynamic-stability claims versus etomidate.
Background: Combined use of hypnotic and opioids during anesthesia inductions decreases blood pressure. Post-induction hypotension (PIHO) is the most common side effect of anesthesia induction. We aimed to compare the difference in mean arterial pressure (MAP) induced by remimazolam with that induced by etomidate in the presence of fentanyl at tracheal intubation. Methods: We assessed 138 adult patients with American Society of Anesthesiologists physical status I–II who underwent elective urological surgery. Patients were randomly allocated to receive either remimazolam or etomidate as alterative hypnotic in the presence of fentanyl during anesthesia induction. Comparable BIS values were achieved in both groups. The primary outcome was the difference in the MAP at tracheal intubation. The secondary outcomes included the characteristics of anesthesia, surgery, and adverse effects. Results: The MAP was higher in the etomidate group than in the remimazolam group at tracheal intubation (108 [22] mmHg vs. 83 [16] mmHg; mean difference, −26; 95% confidence interval [CI], −33 to −19; p < 0.0001). Heart rate was significantly higher in the etomidate group than in the remimazolam group at tracheal intubation. The patients’ condition warranted the administration of ephedrine more frequently in the remimazolam group (22%) than in the etomidate group (5%) ( p = 0.0042) during anesthesia induction. The remimazolam group had a lower incidence of hypertension (0% vs. 9%, p = 0.0133), myoclonus (0% vs. 47%, p < 0.001), and tachycardia (16% vs. 35%, p = 0.0148), and a higher incidence of PIHO (42% vs. 5%, p = 0.001) than the etomidate group during anesthesia induction. Conclusion: Remimazolam was associated with lower MAP and lower heart rate compared to etomidate in the presence of fentanyl at tracheal intubation. Patients in the remimazolam group had a higher incidence of PIHO, and their condition warranted the administration of ephedrine more frequently than in the etomidate group during anesthesia induction.
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Huang et al. (2023) conducted an RCT in Elective urological surgery under general anesthesia (n=133). Remimazolam vs. Etomidate was evaluated on Difference in mean arterial pressure (MAP) at tracheal intubation (MD -26, 95% CI -33 to -19, p=<0.0001). Remimazolam resulted in a significantly lower mean arterial pressure at tracheal intubation compared to etomidate (83 vs. 108 mmHg; mean difference -26) in the presence of fentanyl.
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