Chunyan Zhou,1– 3,* Xinghe Wang,1,3,* Meiyan Zhou,2,4,* Songhai Guo,1– 3 Yu Qi,2,4 Jia Sun,2,4 Liwei Wang1– 4 

1College of Anesthesiology, Xuzhou Medical University, Xuzhou City, Jiangsu Province, People’s Republic of China; 2Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou City, Jiangsu Province, People’s Republic of China; 3Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou City, Jiangsu Province, People’s Republic of China; 4The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou City, Jiangsu Province, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Liwei Wang, Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou City, Jiangsu Province, People’s Republic of China, Email doctorlww@sina.com Jia Sun, Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou City, Jiangsu Province, People’s Republic of China, Email sunjia_66@163.com

Purpose: Post-induction hypotension (PIH) is a common complication in elderly hypertensive patients, posing significant risks of inadequate organ perfusion and increased postoperative morbidity and mortality. This study evaluated the effectiveness of remimazolam in preventing PIH.
Patients and methods: In this randomized controlled trial, 196 elderly hypertensive patients undergoing elective general anesthesia surgery were randomly allocated to either the remimazolam group (Group R) or the propofol group (Group P). Group R received remimazolam at a dose of 0.15– 0.2 mg/kg via intravenous infusion at a rate of 6.0 mg/kg/h, while Group P received propofol at a dose of 1.0– 1.5 mg/kg via intravenous infusion at a rate of 60 mg/kg/h during induction. Primary outcome was the incidence of PIH. Secondary outcomes included the time-weighted average (TWA) of hypotension, norepinephrine usage, key time-point blood pressures from induction to skin incision, and postoperative quality of recovery-15(QoR-15) scale on postoperative day 1 and day 3 (POD1 and POD3).
Results: Among the 196 patients analyzed, Group R showed a significantly lower incidence of PIH compared to the Group P (46.5% vs 73.2%; P < 0.001). Additionally, Group R exhibited reduced frequency of hypotension (0 [0, 2] vs 2 [0, 3], P < 0.001), lower total time in hypotension (0 [0, 4] min vs 4 [0, 7] min, P < 0.001), lower TWA (0 [0, 0.67] mmHg vs 0.56 [0, 4.72] mmHg, P < 0.001), and decreased norepinephrine usage (0 [0, 16] μg vs 16 [0, 28] μg, P < 0.001). Hemodynamic stability was better maintained in Group R during anesthesia induction. No significant differences were observed in QoR-15 scores between the two groups on POD1 and POD3.
Conclusion: Compared with propofol, remimazolam significantly reduces the incidence of PIH in elderly hypertensive patients.

Keywords: post-induction hypotension, remimazolam, propofol, elderly hypertensive patients, time-weighted average