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Influence of remazolam and propofol on intraoperative neurophysiological monitoring during spinal surgery: A

Ying Zhou1, Hai-Fang Li1, Yan-Ping Li1

  • 1Department of Operating Room, The Third Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China.

Medicine
|September 17, 2025
PubMed
Abstract

Insights

Remazolam is a safe anesthetic for spinal surgery, showing fewer IONM signal interferences than propofol. This anesthetic improves surgical safety by maintaining stable hemodynamics and enhancing neurophysiological monitoring.

Area of Science:

  • Anesthesiology
  • Neurosurgery
  • Neurophysiology

Background:

  • Propofol can interfere with intraoperative neurophysiological monitoring (IONM) signals during spinal surgery.
  • Remazolam's impact on IONM signals is not well-established.
  • Evaluating anesthetic effects on IONM is crucial for surgical safety.

Purpose of the Study:

  • To compare the effects of Remazolam versus propofol on IONM signals during spinal surgery.
  • To assess hemodynamic stability and other clinical outcomes under both anesthetics.

Main Methods:

  • Eighty patients undergoing spinal surgery were divided into Remazolam (Group R) and propofol (Group P) groups.
  • IONM signals (SEP, MEP), heart rate, mean arterial pressure, and bispectral index were monitored.
  • Awakening time, extubation time, and adverse effects were evaluated.

Main Results:

  • Remazolam group showed more stable heart rate and mean arterial pressure from intubation onwards.
  • Somatosensory evoked potential (SEP) and motor evoked potential (MEP) amplitudes were higher with Remazolam.
  • SEP and MEP latencies were shorter, and lower remifentanil doses were needed with Remazolam.

Conclusions:

  • Remazolam is a safe and effective alternative anesthetic for spinal surgery.
  • Remazolam minimally interferes with IONM signals, enhancing surgical safety.
  • Remazolam offers improved hemodynamic stability compared to propofol during spinal procedures.
Keywords:
IONMpropofolremazolamspinal surgery

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