Comparative Analysis of the Hemodynamic Effects of Remimazolam and Propofol During General Anesthesia: A
Shota Tsukimoto1, Atsuhiro Kitaura2, Rina Yamamoto2
1Department of Dental Anesthesiology, Kanagawa Dental University, Yokosuka, JPN.
Purpose:
Hypotension is common during anesthesia induction. However, minimal hemodynamic effects of remimazolam anesthesia have been reported. We hypothesized that remimazolam would have weaker hemodynamic effects than would propofol. To test this, we simultaneously evaluated the hemodynamics using the estimated continuous cardiac output (esCCO) system and heart rate variability (HRV) during anesthesia induction.
Methods:
This was a single-center, observational, retrospective study of patients undergoing dental surgery under general anesthesia between 2020 and 2022. Seventy patients were divided into two groups: remimazolam (R group; n=34) and propofol (P group; n=36). The information obtained from the anesthesia records, patient information, esCCO system parameters, and HRV were integrated and analyzed. The percentages of various parameters were set to 100% for the pre-induction phase as the baseline.
Results:
The %MAP (noninvasive mean arterial blood pressure) decreased over a narrower range in the R compared to the P group (-17.8% (-26.3%, -11.9%) vs. -22.6% (-32.9%, -17.0%); P=0.039). The %HR (heart rate) increased significantly in the R group and decreased in the P group (+10.7% (+6.5%, +18.6%) vs. -6.5% (-14.5%, +8.4%); P<0.01). The %SVesCCO (stroke volume calculated using the esCCO system) decreased significantly in both groups, but the R group showed a smaller difference compared to the P group (- 5.1% (-7.7%, -2.1%) vs. -10.0% (-13.8%, -5.6%); P<0.01). The rates of change in %LF nu (normalized unit of low frequency) and %HF nu (normalized unit of high frequency) were lower for the R than for the P group, although the difference was not significant (+6.8% (-14.5%, 32.4%) vs. +9.2% (-7.2%, +59.7%), P=0.30; +7.9% (-51.0%, +66.9%) vs. +22.8% (-26.1%, +61.6%), P=0.57).
Conclusion:
Remimazolam demonstrated a lower MAP reduction rate than propofol. A compensatory increase in HR occurred with a decrease in stroke volume. However, the HR increase was not attributable to the autonomic nervous system.
Insights
Remimazolam caused less blood pressure drop and a compensatory heart rate increase compared to propofol during anesthesia induction. Hemodynamic stability was better with remimazolam.
Area of Science:
- Anesthesiology
- Cardiovascular Physiology
- Pharmacology
Background:
- Hypotension is a frequent complication during anesthesia induction.
- Remimazolam is a newer anesthetic agent with reported minimal hemodynamic effects.
- Comparing remimazolam's hemodynamic profile to propofol is crucial for clinical practice.
Purpose of the Study:
- To investigate the hypothesis that remimazolam has weaker hemodynamic effects than propofol during anesthesia induction.
- To simultaneously evaluate hemodynamics using the estimated continuous cardiac output (esCCO) system and heart rate variability (HRV).
Main Methods:
- A single-center, observational, retrospective study involving 70 patients undergoing dental surgery under general anesthesia.
- Patients were divided into two groups: remimazolam (n=34) and propofol (n=36).
- Hemodynamic parameters including mean arterial blood pressure (MAP), heart rate (HR), and stroke volume (SV) were analyzed using the esCCO system and HRV.
Main Results:
- Remimazolam group showed a narrower range of mean arterial blood pressure decrease compared to the propofol group.
- Heart rate significantly increased in the remimazolam group, while it decreased in the propofol group.
- Stroke volume decreased in both groups, but the reduction was less pronounced with remimazolam.
Conclusions:
- Remimazolam demonstrated a lower rate of mean arterial blood pressure reduction compared to propofol.
- A compensatory increase in heart rate was observed with remimazolam, despite a decrease in stroke volume.
- The observed heart rate increase with remimazolam was not attributed to autonomic nervous system activity.
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