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Comparison of remimazolam-based and propofol-based total intravenous anesthesia on hemodynamics during anesthesia induction in patients undergoing transcatheter aortic valve replacement: a randomized controlled trial

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Abstract

Purpose

This study aimed to compare the hemodynamic effects of remimazolam- and propofol-based total intravenous anesthesia in patients who underwent transcatheter aortic valve replacement.

Methods

This was a single-center, single-blind, randomized controlled trial set at Nara Medical University, Kashihara, Japan. We included 36 patients aged ≥ 20 years scheduled to undergo elective transfemoral transcatheter aortic valve replacement (TAVR) under general anesthesia. The participants were randomly assigned to the remimazolam and propofol groups (n = 18 each). Remimazolam- or propofol-based total intravenous anesthesia was initiated at 12 mg/kg/min or 2.5 mcg/mL via target-controlled infusion, respectively, along with remifentanil. After confirming the loss of consciousness, the administration rate was adjusted using electroencephalographic monitoring. The primary outcome was the rate of arterial hypotension, defined as a mean arterial pressure < 60 mmHg, from anesthesia induction until the beginning of the surgical incision. The total doses of ephedrine and phenylephrine were also assessed.

Results

During anesthesia induction, the arterial hypotension rates were 11.9% and 21.6% in the remimazolam and propofol groups, respectively (P = 0.01). The total dose of ephedrine was higher in the propofol group (14.4 mg) than in the remimazolam group (1.6 mg) (P < 0.001); however, the total dose of phenylephrine was not significantly different between the two groups (propofol 0.31 mg vs. remimazolam: 0.17 mg, P = 0.10).

Conclusion

Remimazolam-based total intravenous anesthesia resulted in a lower hypotension rate than propofol-based total intravenous anesthesia during induction in patients undergoing TAVR. Remimazolam-based total intravenous anesthesia can be used safely during anesthetic induction in patients with severe aortic stenosis.

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Data availability

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

Assistance with the article: Ozu Naoki (Department of Medical Statistics, Nara Medical University, Nara, Japan) advised and assisted with the statistical planning and analysis. We would like to thank Editage (www.editage.com) for the English language editing.

Funding

None.

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Authors and Affiliations

  1. Department of Anesthesiology, Nara Medical University Kashihara, Shijo 840, Nara, 634-8522, Japan

    Taichi Kotani, Mitsuru Ida, Yusuke Naito & Masahiko Kawaguchi

Authors
  1. Taichi Kotani
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  2. Mitsuru Ida
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  3. Yusuke Naito
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  4. Masahiko Kawaguchi
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Contributions

TK: study coordinator, study concept and design, writing of the draft; MI: study concept and design, data interpretation, and editing of the draft; YN: randomization and revision of the manuscript; MK: data interpretation and revision of the manuscript; all the authors: critical review of the manuscript and approval of the final version.

Corresponding author

Correspondence to Mitsuru Ida.

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Conflict of interest

None.

Ethics committee approval

Ethical approval for this study (approval number: 3043, Chairperson: Prof. M. Yoshizumi) was provided by the local ethics committee on 9 September 2021.

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All included patients provided written informed consent.

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Kotani, T., Ida, M., Naito, Y. et al. Comparison of remimazolam-based and propofol-based total intravenous anesthesia on hemodynamics during anesthesia induction in patients undergoing transcatheter aortic valve replacement: a randomized controlled trial. J Anesth 38, 330–338 (2024). https://doi.org/10.1007/s00540-024-03311-x

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  • DOI: https://doi.org/10.1007/s00540-024-03311-x

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