Comparing IL-6 and IL-10 Serum Levels and Changes Using Propofol and Remimazolam: A Prospective Randomized Controlled...

Surgical stress alters cytokine concentrations, triggering systemic inflammatory responses and immune defense mechanisms. Interleukin-6 (IL-6) and interleukin-10 (IL-10) play important roles in perioperative inflammatory responses. General anesthetics have been shown to affect immune function during surgery. Propofol modulates inflammation by decreasing IL-6, IL-10, and tumor necrosis factor-alpha (TNF-α) levels. Remimazolam, a new ultra-short-acting benzodiazepine, is increasingly used as an induction and maintenance anesthetic agent. However, the effects of remimazolam on inflammatory cytokines and perioperative hemodynamic variables remain unclear.

This prospective randomized study included 46 patients undergoing total laparoscopic hysterectomy or laparoscopic myomectomy under total intravenous anesthesia. Blood samples were collected at four time points: before anesthesia (T0), at the end of surgery (T1), 1.5 h after surgery (T2), and 24 h after surgery (T3). Serum IL-6, IL-10, and TNF-α levels were measured using enzyme-linked immunosorbent assays. However, TNF-α values were below the detectable range of the assay and were therefore excluded from meaningful statistical analysis.

No significant intergroup differences were observed in IL-6 or IL-10 levels (F(2.10, 90.08) = 2.43, P = 0.092; F(1.277, 54.905) = 2.44, P = 0.117) or the IL-6/IL-10 ratio (F(1.874, 80.586) = 0.46, P = 0.620). Compared with the propofol group, the remimazolam group demonstrated significantly higher intraoperative bispectral index (BIS), heart rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure values. Postoperative oxycodone requirements in the post-anesthesia care unit were significantly higher in the propofol group. TNF-α levels remained below the detectable range of the assay and could not be meaningfully analyzed.

No significant intergroup differences were observed in perioperative IL-6 and IL-10 responses between remimazolam and propofol. However, because anesthetic depth may not have been fully equivalent between groups, as reflected by higher BIS values in the remimazolam group, the cytokine and hemodynamic findings should be interpreted cautiously. The absence of statistically significant differences should not be interpreted as evidence of immunologic equivalence between the two anesthetic agents. Further large-scale studies with standardized anesthetic depth are required to clarify the immunomodulatory and hemodynamic effects of remimazolam.