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.

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).