Journal of thoracic disease · 2026
Vasopressor requirements and hemodynamic stability during anesthesia using remimazolam and sevoflurane in patients undergoing minimally invasive aortic valve replacement surgery: a prospective randomized controlled study.
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Lee Jimin, Shin Sang-Wook, Yoon Ji-Uk, Kim Hye-Jin, Yoon Jung-Pil, Shon Hong-Sik, Lee Da Eun, Kim Hee Young
Аннотация
BACKGROUND: Anesthetic agents can cause hypotension, and patients with severe aortic stenosis (AS) require special attention. This study compared the effects of remimazolam versus sevoflurane anesthesia on hemodynamics in patients with severe AS undergoing minimally invasive aortic valve replacement (AVR).
METHODS: Patients were assigned to the remimazolam (R) or sevoflurane (S) group. Group R received remimazolam 6 mg/kg/h for induction and 1-2 mg/kg/h for maintenance with remifentanil. Group S received 1% propofol at 1-2 mg/kg for induction and sevoflurane with remifentanil for maintenance. Vasopressor requirement and hypotensive events were compared.
RESULTS: Sixty-four patients were enrolled, and one patient was excluded from the study. The infusion rate of norepinephrine was lower in group R during post-cardiopulmonary bypass (CPB) (0.040±0.051 vs. 0.085±0.080 mcg/kg/min, P=0.03). The proportion of hypotension was lower in group R during post-CPB (80.2%±21.5% vs. 91.9%±25.2%, P=0.04), and the entire duration of anesthesia (66.5%±16.9% vs. 76.0%±16.2%, P=0.03).
CONCLUSIONS: Compared to conventional sevoflurane anesthesia, remimazolam-based total intravenous anesthesia was associated with more stable hemodynamics and reduced vasopressor requirement during pre-CPB, and post-CPB in patients with severe AS undergoing minimally invasive AVR.
TRIAL REGISTRATION: The clinical research was registered at ClinicalTrials.gov (Ref: NCT05864625).
METHODS: Patients were assigned to the remimazolam (R) or sevoflurane (S) group. Group R received remimazolam 6 mg/kg/h for induction and 1-2 mg/kg/h for maintenance with remifentanil. Group S received 1% propofol at 1-2 mg/kg for induction and sevoflurane with remifentanil for maintenance. Vasopressor requirement and hypotensive events were compared.
RESULTS: Sixty-four patients were enrolled, and one patient was excluded from the study. The infusion rate of norepinephrine was lower in group R during post-cardiopulmonary bypass (CPB) (0.040±0.051 vs. 0.085±0.080 mcg/kg/min, P=0.03). The proportion of hypotension was lower in group R during post-CPB (80.2%±21.5% vs. 91.9%±25.2%, P=0.04), and the entire duration of anesthesia (66.5%±16.9% vs. 76.0%±16.2%, P=0.03).
CONCLUSIONS: Compared to conventional sevoflurane anesthesia, remimazolam-based total intravenous anesthesia was associated with more stable hemodynamics and reduced vasopressor requirement during pre-CPB, and post-CPB in patients with severe AS undergoing minimally invasive AVR.
TRIAL REGISTRATION: The clinical research was registered at ClinicalTrials.gov (Ref: NCT05864625).