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Randomized Controlled Trial
. 2024 Mar 5;60(3):432.
doi: 10.3390/medicina60030432.

Effect of Remimazolam- versus Propofol-Based Total Intravenous General Anesthesia on Intraoperative Hemodynamic Stability for Major Spine Surgery in the Prone Position: A Randomized Controlled Trial

Ha-Jung Kim  1 , Ji-Young Kim  1 , Hyeok-Seong Park  2 , Hyungtae Kim  1 , Young-Jin Ro  1 , Won Uk Koh  1
Affiliations
Randomized Controlled Trial

Effect of Remimazolam- versus Propofol-Based Total Intravenous General Anesthesia on Intraoperative Hemodynamic Stability for Major Spine Surgery in the Prone Position: A Randomized Controlled Trial

Ha-Jung Kim et al. Medicina (Kaunas). .

Abstract

Background and Objectives: Remimazolam offers advantages over propofol in terms of hemodynamic stability. However, it remains unclear whether remimazolam-based total intravenous anesthesia (TIVA) can reduce intraoperative hypotension compared to propofol-based TIVA, especially after prone positioning. In this study, we compared the effects of remimazolam- and propofol-based TIVA on intraoperative hemodynamic stability in patients undergoing surgery in the prone position. Materials and Methods: This study randomly assigned patients undergoing major spinal surgery in the prone position to the propofol or remimazolam group. Target-controlled infusion (2-3.5 μg/mL for induction and 2-3 μg/mL for maintenance) was used in the propofol group and continuous infusion (6 mg/kg/h for induction and 1-2 mg/kg/h for maintenance) was used in the remimazolam group; target-controlled infusion (3-5 ng/mL) of remifentanil was performed in both groups. The primary outcomes were the incidence of hypotensive episodes during the first hour after prone positioning. The secondary outcomes included the incidence of severe hypotension and the total amount of inotropic or vasopressor medication. Systolic and mean arterial pressure, heart rate, cardiac index and output, stroke volume, stroke volume variation, and pleth variability index were also evaluated. These variables were recorded per minute for the first 10 min after prone positioning, and every 10 min thereafter. Results: The study enrolled 94 patients (47 patients in each group). The incidence of hypotension or severe hypotension did not differ significantly between the two groups during the first hour after prone positioning. The total amount of ephedrine administered during the first hour after prone positioning was lesser (p = 0.020) and the mean arterial pressure during the initial 10 min after prone positioning was higher in the remimazolam group (p = 0.003). Conclusions: Our study uncovered no significant differences in the incidence of hypotension between remimazolam- and propofol-based TIVA in patients undergoing major spine surgery in prone position.

Keywords: perioperative hypotension; prone position; propofol; remimazolam; spinal surgery.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Research protocols. Abbreviation: CI, continuous infusion; TCI, target-controlled infusion; LOC, loss of consciousness; SBP, systolic blood pressure.
Figure 2
Figure 2
Flow chart of patient enrollment.
Figure 3
Figure 3
Serial changes in systolic arterial pressure (a), mean arterial pressure (b), heart rate (c), cardiac index (d), cardiac output (e), stroke volume (f), stroke volume variant (g) and pleth variability index (h) during the initial 10 min after prone positioning. Abbreviations: SAP, systolic arterial pressure; MAP, mean arterial pressure; HR, heart rate; CI, cardiac index; CO, cardiac output; SV, stroke volume; SVV, stroke volume variant; PVi, pleth variability index.
Figure 3
Figure 3
Serial changes in systolic arterial pressure (a), mean arterial pressure (b), heart rate (c), cardiac index (d), cardiac output (e), stroke volume (f), stroke volume variant (g) and pleth variability index (h) during the initial 10 min after prone positioning. Abbreviations: SAP, systolic arterial pressure; MAP, mean arterial pressure; HR, heart rate; CI, cardiac index; CO, cardiac output; SV, stroke volume; SVV, stroke volume variant; PVi, pleth variability index.
Figure 4
Figure 4
Serial changes in (a) systolic arterial pressure, (b) mean arterial pressure, (c) heart rate, (d) cardiac index, (e) cardiac output, (f) stroke volume, (g) stroke volume variation and (h) pleth variability index during the first hour after prone positioning. Abbreviations: SAP, systolic arterial pressure; MAP, mean arterial pressure; HR, heart rate; CI, cardiac index; CO, cardiac output; SV, stroke volume; SVV, stroke volume variation; PVi, pleth variability index.
Figure 4
Figure 4
Serial changes in (a) systolic arterial pressure, (b) mean arterial pressure, (c) heart rate, (d) cardiac index, (e) cardiac output, (f) stroke volume, (g) stroke volume variation and (h) pleth variability index during the first hour after prone positioning. Abbreviations: SAP, systolic arterial pressure; MAP, mean arterial pressure; HR, heart rate; CI, cardiac index; CO, cardiac output; SV, stroke volume; SVV, stroke volume variation; PVi, pleth variability index.
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