Effect of remimazolam vs. propofol on hemodynamics during general anesthesia induction in elderly patients: Single-center, randomized controlled trial

The current study aimed to compare the effects between remimazolam and propofol on hemodynamic stability during the induction of general anesthesia in elderly patients. We used propofol at a rate of 60 mg/(kg·h) in the propofol group (group P) or remimazolam at a rate of 6 mg/(kg·h) in the remimazolam group (group R) for the induction. A processed electroencephalogram was used to determine whether the induction was successful and when to stop the infusion of the study drug. We measured when patients entered the operating room (T₀), when the induction was successful (T₁), and when before (T₂) and 5 min after successful endotracheal intubation (T₃). We found that mean arterial pressure (MAP) was lower at T_1–3, compared with T₀ in both groups, but higher at T₂ in the group R, while ΔMAP_T0–T2 and ΔMAP_max were smaller in the group R (ΔMAP_T0–T2: the difference between MAP at time point T₀ and T₂, ΔMAP_max: the difference between MAP at time point T₀ and the lowest value from T₀ to T₃). Cardiac index and stroke volume index did not differ between groups, whereas systemic vascular resistance index was higher at T_1–3 in the group R. These findings show that remimazolam, compared with propofol, better maintains hemodynamic stability during the induction, which may be attributed to its ability to better maintain systemic vascular resistance levels.