Effects of Remimazolam Anesthesia in Patients Undergoing Deep Inferior Epigastric Perforator Flap Reconstruction for Breast Cancer: A Retrospective Cohort Study.

In deep inferior epigastric perforator (DIEP) free flap surgery for breast reconstruction, vasopressors may cause vasoconstriction and impair flap perfusion, potentially increasing the risk of complications. In this study, we aimed to determine the effects of remimazolam anesthesia on intraoperative vasopressor requirements and postoperative outcomes in patients undergoing DIEP flap reconstruction compared with conventional anesthesia. We conducted a retrospective cohort study of DIEP flap procedures performed between March 2021 and March 2022 at a single institution. Patients were stratified according to the anesthetic regimen (sevoflurane, propofol, and remimazolam). The primary outcome was the total intraoperative norepinephrine requirement. Among 102 initially identified patients, 75 met the inclusion criteria. The remimazolam group required significantly less norepinephrine than the sevoflurane and propofol groups (202.1 µg vs. 1558.6 µg and 926.6 µg, respectively; P < 0.001), with comparable reductions in ephedrine use. Thus, remimazolam may serve as an effective alternative to sevoflurane and propofol anesthesia in terms of reducing intraoperative vasopressor requirements and is potentially better in maintaining hemodynamic stability during DIEP free flap reconstruction.