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Comparison of hypotension incidence between remimazolam and propofol in patients with hypertension undergoing neurosurgery: prospective, randomized, single-blind trial

Authors
 Seung Ho Choi  ;  Kyeong Tae Min  ;  Eun Kyung Park  ;  Sujung Park 
Citation
 BMC ANESTHESIOLOGY, Vol.24(1) : 198, 2024-06 
Journal Title
BMC ANESTHESIOLOGY
Issue Date
2024-06
MeSH
Adult ; Aged ; Anesthetics, Intravenous* / adverse effects ; Benzodiazepines* / administration & dosage ; Benzodiazepines* / adverse effects ; Female ; Humans ; Hypertension* / drug therapy ; Hypertension* / epidemiology ; Hypotension* / chemically induced ; Hypotension* / epidemiology ; Incidence ; Male ; Middle Aged ; Neurosurgical Procedures* / adverse effects ; Neurosurgical Procedures* / methods ; Propofol* / administration & dosage ; Propofol* / adverse effects ; Prospective Studies ; Single-Blind Method ; Young Adult
Keywords
Anesthetic induction ; Drug therapy ; Hypertension ; Propofol ; Remimazolam
Abstract
Background Remimazolam, a newer benzodiazepine that targets the GABAA receptor, is thought to allow more stable blood pressure management during anesthesia induction. In contrast, propofol is associated with vasodilatory effects and an increased risk of hypotension, particularly in patients with comorbidities. This study aimed to identify medications that can maintain stable vital signs throughout the induction phase.Methods We conducted a single-center, two-group, randomized controlled trial to investigate and compare the incidence of hypotension between remimazolam- and propofol-based total intravenous anesthesia (TIVA). We selected patients aged between 19 and 75 years scheduled for neurosurgery under general anesthesia, who were classified as American Society of Anesthesiologists Physical Status I-III and had a history of hypertension.Results We included 94 patients in the final analysis. The incidence of hypotension was higher in the propofol group (91.3%) than in the remimazolam group (85.4%; P = 0.057). There was no significant difference in the incidence of hypotension among the various antihypertensive medications despite the majority of patients being on multiple medications. In comparison with the propofol group, the remimazolam group demonstrated a higher heart rate immediately after intubation.Conclusions Our study indicated that the hypotension incidence of remimazolam-based TIVA was comparable to that of propofol-based TIVA throughout the induction phase of EEG-guided anesthesia. Both remimazolam and propofol may be equally suitable for general anesthesia in patients undergoing neurosurgery.Trial registration Clinicaltrials.gov (NCT05164146).
Files in This Item:
T202405471.pdf Download
DOI
38834996
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Min, Kyeong Tae(민경태) ORCID logo https://orcid.org/0000-0002-3299-4500
Park, Eun Kyung(박은경)
Choi, Seung Ho(최승호) ORCID logo https://orcid.org/0000-0001-8442-4406
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/200531
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