Hemodynamic stability with remimazolam versus propofol for general anesthesia in acute ischemic stroke thrombectomy: a randomized controlled trial

The optimal anesthetic regimen for acute ischemic stroke (AIS) patients undergoing endovascular thrombectomy (EVT) remains debated. This randomized, double-blind, controlled trial compared the impact of remimazolam versus propofol on intraoperative hemodynamics in this setting. Seventy-four AIS patients were randomly assigned to receive either remimazolam-based or propofol-based general anesthesia. The incidence of intraoperative hypotension was the primary outcome. Vasopressor requirement, recovery times, and neurological outcomes were also assessed. Although the incidence of hypotension during anesthesia induction was comparable between the groups (75.68% vs. 70.27%, p = 0.601), it was significantly lower in the remimazolam group than in the propofol group during anesthesia maintenance (35.14% vs. 86.49%, p < 0.001). The remimazolam group also required significantly less vasopressor and exhibited a smaller maximum decrease in MAP (42 (35, 54) mmHg vs. 56 (47, 64) mmHg, p < 0.001). While not statistically significant, favorable trends were observed in the remimazolam group for neurological improvement at discharge. In conclusion, for AIS patients undergoing EVT, remimazolam provides superior hemodynamic stability compared to propofol, significantly reducing hypotension during anesthesia maintenance, without compromising recovery.Trial registration: This study was registered at the Chinese Clinical Trail Registry on 23/10/2023 (Registration number ChiCTR2300076880).