Effects of Remimazolam vs. Sevoflurane Anesthesia on Intraoperative Hemodynamics in Patients with Gastric Cancer Undergoing Robotic Gastrectomy: A Propensity Score-Matched Analysis

Abstract

Remimazolam has been suggested to improve the maintenance of hemodynamic stability when compared with other agents used for general anesthesia. This study aimed to compare the effects of remimazolam and sevoflurane anesthesia on hemodynamic stability in patients undergoing robotic gastrectomy. We retrospectively reviewed the electronic medical records of 199 patients who underwent robotic gastrectomy with sevoflurane (n = 135) or remimazolam (n = 64) anesthesia from January to November 2021. Propensity scores were used for 1:1 matching between the groups. The primary outcome was the difference in use of intraoperative vasopressors between groups. Secondary outcomes included differences in incidence and dose of vasopressors, as well as intraoperative hemodynamic variables, between groups. Remimazolam anesthesia was associated with a significantly less frequent use of ephedrine (odds ratio (OR): 0.13; 95% confidence interval (CI): 0.05–0.38, p < 0.001), phenylephrine (OR: 0.12; 95% CI: 0.04–0.40, p < 0.001), and any vasopressor (OR: 0.06; 95% CI: 0.02–0.25, p < 0.001) compared with sevoflurane anesthesia. Remimazolam anesthesia enables better maintenance of hemodynamic stability than sevoflurane anesthesia. Thus, remimazolam anesthesia may be beneficial for patients who are expected to experience hypotension due to the combined effects of CO2 pneumoperitoneum and the head-up position utilized during robotic gastrectomy.

Effects of Remimazolam Combined with Esketamine Anesthesia on Circulatory and Respiratory Function during Painless Gastroenteroscopy

“…The incidence of the abovementioned complications in the 53 study subjects in the observation group was 1.89% (1/53) for complicated nausea, 3.77% (2/53) for vomiting, 1.89% (1/53) for rigor, and 7.55% (4/53) for total postexamination/procedure complications; in the control group, the total incidence of nausea, vomiting, rigor, and postexamination/procedure complications were 5.66%, 5.66%, 3.77%, and 13.21%, respectively. It is consistent with the previous studies [ 11 ].…”

“…In this study, the induction of anesthesia, patient awakening, and recovery time of orientation were statistically analyzed in both the groups, and the results showed that the induction of anesthesia, patient awakening, and recovery time of orientation were rapid in both the groups, but there was no difference ( P > 0.05); comparing the circulatory and respiratory functions before and after anesthesia in both the groups, it was found that the mean arterial pressure, heart rate, respiratory rate, and SpO 2 levels were not statistically significant and were comparable ( P > 0.05). The circulatory and respiratory functional status of all 53 study subjects in the observation group after anesthesia was superior to that of the 53 patients in the control group ( P < 0.05), which was similar to the previous studies [ 10 , 11 ]. Meanwhile, among the 106 study subjects in this study, a total of 25 study subjects had adverse reactions in blood pressure, heart rate, SpO 2 , respiration, and other vital signs during the progress of the examination/surgery, accounting for 35.85% (38/106) of the total study subjects, among which a total of 4 patients (3.77%) of the 35 study subjects who had adverse reactions had hypotension (4/106); 7.55% of the study subjects had bradycardia (8/106); a total of 4 patients (3.77% of the total study subjects) had decreased oxygen saturation; 8.49% (9/106) of the patients had respiratory depression; and 13 patients (12.26%) had transient local pain at the injection site.…”

“…e circulatory and respiratory functional status of all 53 study subjects in the observation group after anesthesia was superior to that of the 53 patients in the control group (P < 0.05), which was similar to the previous studies [10,11]. Meanwhile, among the 106 study subjects in this study, a total of 25 study subjects had adverse reactions in blood pressure, heart rate, SpO 2 , respiration, and other vital signs during the progress of the examination/surgery, accounting for 35.85% (38/106) of the total study subjects, among which a total of 4 patients (3.77%) of the 35 study subjects who had adverse reactions had hypotension (4/106); 7.55% of the study subjects had bradycardia (8/106); a total of 4 patients (3.77% of the total study subjects) had decreased oxygen saturation; 8.49% (9/106) of the patients had respiratory depression; and 13 patients (12.26%) had transient local pain at the injection site.…”

Clinical profile of a new anesthetic: remimazolam

“…Remimazolam has been approved for use as an anesthetic and sedative for adults; however, the scope of approval varies from country to country, e.g., it is used as a general anesthetic in Japan and South Korea and a procedural sedative also in South Korea, the USA, China, and European countries [1]. After market approval, remimazolam has been used as sedative in various procedures, such as gastrointestinal endoscopy, colonoscopy, and bronchoscopy [4,5], and as anesthetic in various surgeries, such as urologic surgery, robotic gastrectomy, and cardiac surgery [6][7][8][9][10][11][12][13][14].…”

Profile of Remimazolam in Anesthesiology: A Narrative Review of Clinical Research Progress

“…Common adverse events of remimazolam include hypotension, dizziness, headache, reduced respiratory frequency, and increased blood bilirubin. 50,51 Phase I-III studies reported a 2.65-6.45% incidence of hypotension. 4,[8][9][10] In a phase III clinical trial, the incidence of respiratory suppression in ASA III/IV patients receiving remimazolam was as high as 19.4%.…”