Hypotension incidence comparison between remimazolam and propofol in hypertensive patients undergoing spinal surgery

This study aimed to compare the incidence of hypotension between remimazolam and propofol in hypertensive patients undergoing spinal surgery.

We conducted a retrospective analysis of 194 hypertensive patients who received either remimazolam (n=99) or propofol (n=95) as the primary anesthetic during spinal surgery under general anesthesia. Hemodynamic parameters and bispectral index (BIS) were continuously monitored. The primary outcome was the incidence of intraoperative hypotension, defined as a mean arterial pressure (MAP) below 80% of baseline within 13 minutes of drug administration. Severe hypotension was defined as MAP below 70% of baseline. Postoperative adverse events, including postoperative nausea and vomiting (PONV), injection pain, dizziness, delirium, and hypoxemia, were also recorded.

The incidence of hypotension was significantly lower in the remimazolam group compared to the propofol group (82.83% vs. 93.68%, P=0.019). The remimazolam group demonstrated more stable MAP at key time points (5-12 minutes post-induction) and a lower incidence of PONV (15.15% vs. 29.47%, P=0.016) and injection pain (2.02% vs. 26.32%, P<0.001). Multivariate logistic regression identified remimazolam as an independent protective factor against hypotension (odds ratio [OR] =0.435, 95% confidence interval [CI]: 0.210-0.901, P=0.025).

For hypertensive patients undergoing spinal surgery, remimazolam is associated with a significantly lower risk of intraoperative hypotension and fewer adverse events compared to propofol, suggesting it may be a safer anesthetic option for this population.