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Differential effects of remimazolam and propofol on heart rate variability during anesthesia induction

Gen Hasegawa1, Naoyuki Hirata2, Yusuke Yoshikawa1

  • 1Department of Anesthesiology, Sapporo Medical University School of Medicine, 291, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.

Journal of Anesthesia
|January 14, 2022
PubMed
Abstract

Insights

Remimazolam and propofol reduce autonomic nervous activity during anesthesia induction. Remimazolam preserves autonomic balance, unlike propofol which shifts it towards sympathetic dominance.

Area of Science:

  • Anesthesiology
  • Autonomic Nervous System Research
  • Cardiovascular Physiology

Background:

  • Autonomic nervous system (ANS) activity during anesthesia induction is not fully understood.
  • Differential effects of anesthetic agents on ANS require elucidation.

Purpose of the Study:

  • To investigate the distinct effects of remimazolam and propofol on autonomic nervous activity.
  • To compare the impact of remimazolam versus propofol on heart rate variability indices during anesthesia induction.

Main Methods:

  • Thirty patients were randomized into remimazolam or propofol groups for anesthesia induction.
  • Hemodynamics and heart rate variability (HRV) indices, including low frequency (LF) and high frequency (HF) power, were recorded pre- and post-anesthesia.
  • Normalized LF (LF nu) and HF (HF nu) were calculated to assess sympathetic and parasympathetic activity balance.

Main Results:

  • Both remimazolam and propofol decreased blood pressure and HRV power spectral density.
  • Remimazolam did not alter LF nu or HF nu, while propofol increased LF nu and decreased HF nu (P=0.020).
  • The change in LF nu (ΔLF nu) was significantly smaller in the remimazolam group compared to the propofol group (1.4±23.6% vs 19.3±22.4%, P=0.0415).

Conclusions:

  • Both remimazolam and propofol reduce autonomic nervous activity during anesthesia induction.
  • Remimazolam effectively preserves the balance between sympathetic and parasympathetic activity.
  • Propofol, in contrast, shifts autonomic balance towards sympathetic dominance.
Keywords:
Autonomic nervous activityHeart rate variabilityRemimazolam

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