Clinical application of remimazolam benzenesulfonate in elderly patients undergoing laparoscopic cholecystectomy under intravenous general anesthesia

Background

Elderly patients undergoing laparoscopic cholecystectomy (LC) are more vulnerable to hemodynamic instability and anesthesia-related adverse events. Remimazolam benzenesulfonate may be a useful alternative to propofol, but comparative evidence remains limited.

Aim

To compare the efficacy and safety of remimazolam benzenesulfonate and propofol in elderly patients undergoing LC.

Methods

A total of 120 elderly patients scheduled for LC were randomized based on random number table and opaque sealed envelopes into 2 groups (n = 60 each): A propofol control group (CG) and a remimazolam benzenesulfonate observation group (OG). Anesthesia induction was intravenous propofol (1.5 mg/kg) or remimazolam benzenesulfonate (0.2 mg/kg), and rocuronium bromide (0.6 mg/kg) and sufentanil (0.4 ug/kg) in both groups. Anesthesia maintenance included targeted intravenous infusion of the assigned sedatives with remifentanil; intermittent rocuronium was used to keep a train-of-four ratio of ≤ 0.2. The primary outcome was mean arterial pressure (MAP). Secondary outcomes: Oxygen saturation, heart rate (HR), Bispectral index (BIS), perioperative use of vasoactive drugs, Riker Sedation-Agitation Scale (RSAS), Visual Analogue Scale (VAS), Mini Mental State Examination (MMSE), and incidence of adverse reactions.

Results

After applying the predefined inclusion and exclusion criteria, 59 patients in both groups completed the trial. Relative to the CG, the OG had a longer induction time and delayed attainment of BIS < 60 (P < 0.05). However, the OG was found to have more stable MAP and HR throughout the perioperative period, lower consumption of vasoactive agents, and fewer adverse events (P < 0.05). Post-extubation RSAS scores were also lower in the OG (P < 0.05). Postoperatively, the OG had greater MMSE scores at 6 hours and lower VAS pain scores at 1 hour and 6 hours (P < 0.05). No significant variances between groups were revealed at other time points.

Conclusion

Relative to propofol, remimazolam benzenesulfonate has more stable hemodynamics and a lower incidence of adverse reactions during total intravenous anesthesia in elderly patients undergoing LC. While remimazolam showed benefits in early postoperative recovery, cognitive function, and pain control, these benefits were lost over time.