Efficacy of remimazolam besylate versus propofol on hemodynamics during anesthetic induction in elderly patients undergoing bronchoscopy: a randomized controlled trial

The effect of remimazolam besylate versus propofol on hemodynamics during bronchoscopy remains uncertain. To test the hypothesis that remimazolam besylate can provide a more stable hemodynamic profile than propofol in the elderly for bronchoscopy under general anesthesia and calculate the optimal induction doses. A total of 232 patients aged ≥ 65 years who underwent bronchoscopy were enrolled. Participants were randomly divided into the remimazolam besylate group or propofol group for sedation. The patients received titrated induction with remimazolam besylate or propofol combined with remifentanil and maintenance with assigned agents. Vital signs and bispectral index (BIS) changes were monitored. The cognitive test was performed before and after operation. The primary outcome was the incidence of hypotension during induction. Secondary key outcomes included average real variability of mean arterial pressure, titrated dose of remimazolam besylate and propofol during induction, and the BIS changes. Other outcomes included baseline characteristics, intraoperative anesthesia-related data, and other adverse events. The remimazolam besylate group had a significantly lower incidence of hypotension during anesthetic induction (28.44% vs. 73.33%,95% CI 1.88–3.56, P < 0.001). The average real variability of mean arterial pressure of remimazolam besylate group was 8.25 ((Interquartile range [IQR] 6.33–11.50) mmHg/min smaller than that 12.33 (IQR 9.00–14.67) mmHg/min in propofol group ( P < 0.001). The optimal dose of remimazolam besylate by titration during induction was 0.16 (IQR 0.15–0.18) mg/kg. The mean BIS values in remimazolam besylate group was higher than that in propofol group [59.35 (IQR 53.15–65.11) vs. 55.13 (IQR 51.72–61.75), P < 0.001]. Remimazolam besylate was superior to propofol in terms of hemodynamics for the elderly undergoing bronchoscopy. Furthermore, we proposed a titrated dose of remimazolam besylate 0.16 mg/kg during induction in this patient population.