Effects of remimazolam, cipepofol and propofol on circulation during induction period of general anesthesia

Objective To observe the effects of remimazolam, cipepofol, and propofol on hemodynamics, blood glucose, and lactate levels during general anesthesia induction. Methods A total of 126 elective surgery patients at the Second Affiliated Hospital of Nanjing Medical University from August to November 2023, undergoing non-cardiothoracic and neurosurgical procedures under general anesthesia, were included. Patients were randomly assigned using a random number table into three groups: remimazolam group, cipepofol group, and propofol group, with 42 patients in each group. Anesthesia induction included intravenous sufentanil 0.2-0.3 μg/kg followed by administration of the study drugs: remimazolam group received remimazolam 0.3 mg/kg, cipepofol group received cipepofol 0.4 mg/kg (0.3 mg/kg for patients over 70 years), and propofol group received propofol 2.0 mg/kg (1.5 mg/kg for patients over 70 years). Rocuronium 0.6 mg/kg was injected after loss of eyelash reflex, followed by placement of a laryngeal mask for ventilation control. Heart rate (HR), mean arterial pressure (MAP), and bispectral index (BIS) values were recorded at upon entry (T0), before intubation (T1), immediately after intubation (T2), and 3 minutes after intubation (T3). Blood glucose and lactate levels were recorded at T1 and T3. Incidence of injection pain, hypotension, bradycardia, hiccup, agitation during emergence, patient satisfaction upon leaving the recovery room, intraoperative awareness, postoperative dizziness, nausea, and vomiting were also documented. Results A total of 42 cases were included in the remimazolam group, 36 cases in the cipepofol group, and 39 cases in the propofol group. The incidence of hypotension during induction was 9 cases (21%) in the remimazolam group, 15 cases (42%) in the cipepofol group, and 21 cases (54%) in the propofol group, and the difference among three groups was significant (χ2=9.204, P=0.010). The remimazolam group had a significantly lower incidence of hypotension compared to the propofol group (P＜0.017). Bradycardia during induction occurred in 6 cases (14%) in the remimazolam group, 18 cases (50%) in the cipepofol group, and 12 cases (31%) in the propofol group, with significant difference among three groups (χ2=11.607, P=0.003). The remimazolam group had a significantly lower incidence of bradycardia compared to the cipepofol group(P＜0.017). Multivariate analysis indicated that the remimazolam was an independent protective factor against hypotension (OR=0.199, 95%CI: 0.073-0.549, P=0.002) and bradycardia (OR=0.173, 95%CI: 0.057-0.520, P=0.002) during induction. There was statistically significant difference in the incidence of injection pain among the remimazolam group, cipepofol group, and propofol group (14% vs 0 vs 54%,χ2=33.429, P＜0.001). Conclusion Remimazolam, cipepofol, and propofol can be used for anesthesia induction. Propofol could induce hypotension, while propofol notably induces bradycardia. Remimazolam acts as an independent protective factor against hypotension and bradycardia during induction.