A randomized trial evaluating hemodynamics during minor hepatectomy under general anesthesia combined with thoracic...

Hemodynamic instability is common during hepatectomy under general anesthesia combined with thoracic epidural anesthesia, along with intraoperative low central venous pressure (LCVP). We hypothesized that remimazolam-based anesthesia would improve hemodynamic instability compared to propofol-based anesthesia.

The patients undergoing elective hepatectomy under general anesthesia combined with thoracic epidural anesthesia were enrolled and randomly allocated to either group R (remimazolam anesthesia) or group P (propofol anesthesia). The hemodynamic instability was evaluated by the hemodynamic instability scores (HI-score) at induction period, during hepatectomy and hemostasis. The advanced hemodynamic parameters (cardiac index CI, system vascular resistance index SVRI) were recorded. The secondary outcomes including length of PACU stay, changes in hemoglobin level, major cardiovascular events within postoperative 3 days, length of hospital stay, postoperative ambulation time, and time to first flatus were also documented.

A total of 72 subjects were randomized, and 33 ones under minor hepatectomy surgery in each group were analyzed finally. There was significant hemodynamics instability in both groups, however, the total HI-score was significantly lower in group R (22.8 ± 2.1) than group P (33.0 ± 4.1, P = 0.029). Further analysis demonstrated that the HI-scores were also lower in group R than group P during induction period (11.9 ± 1.0 vs. 22.6 ± 4.2, P = 0.017), hepatectomy period (23.2 ± 3.2 vs. 38.5 ± 6.0, P = 0.027) and hemostasis period (22.2 ± 2.8 vs. 33.5 ± 3.8, P = 0.019). Nevertheless, compared with propofol-based anesthesia, remimazolam-based anesthesia did not reduce incidence of major cardiovascular events and length of hospital stay (P > 0.05).

When compared with propofol-based anesthesia, remimazolam-based anesthesia has better intraoperative hemodynamic stability during minor hepatectomy surgery under combined general-epidural anesthesia. However, this improved hemodynamics may not necessarily translate into better perioperative outcomes.

Registered at ClinicalTrials.gov (Registration No. NCT06565715 Principal investigator Jun Zhang Date of registration 08/21/2024 https://clinicaltrials.gov/study/NCT06565715?term=NCT06565715&rank=1 ).