Effects of Remimazolam vs. Sevoflurane Anesthesia on Intraoperative Hemodynamics in Patients with Gastric Cancer Undergoing Robotic Gastrectomy: A Propensity Score-Matched Analysis

Abstract

Remimazolam has been suggested to improve the maintenance of hemodynamic stability when compared with other agents used for general anesthesia. This study aimed to compare the effects of remimazolam and sevoflurane anesthesia on hemodynamic stability in patients undergoing robotic gastrectomy. We retrospectively reviewed the electronic medical records of 199 patients who underwent robotic gastrectomy with sevoflurane (n = 135) or remimazolam (n = 64) anesthesia from January to November 2021. Propensity scores were used for 1:1 matching between the groups. The primary outcome was the difference in use of intraoperative vasopressors between groups. Secondary outcomes included differences in incidence and dose of vasopressors, as well as intraoperative hemodynamic variables, between groups. Remimazolam anesthesia was associated with a significantly less frequent use of ephedrine (odds ratio (OR): 0.13; 95% confidence interval (CI): 0.05−0.38, p < 0.001), phenylephrine (OR: 0.12; 95% CI: 0.04−0.40, p < 0.001), and any vasopressor (OR: 0.06; 95% CI: 0.02−0.25, p < 0.001) compared with sevoflurane anesthesia. Remimazolam anesthesia enables better maintenance of hemodynamic stability than sevoflurane anesthesia. Thus, remimazolam anesthesia may be beneficial for patients who are expected to experience hypotension due to the combined effects of CO2 pneumoperitoneum and the head-up position utilized during robotic gastrectomy.

Keywords: hemodynamic stability; remimazolam anesthesia; robotic gastrectomy; sevoflurane anesthesia.

Figure 1

Flow diagram of the study. ICU, intensive care unit; HTN, hypertension; DM, diabetes mellitus; ASA, American Society of Anesthesiologists; LN, lymph node.

Figure 2

Distribution of propensity scores before and after matching. PSM, propensity score matching.

Figure 3

Forest plot and bar graph depicting the association of (A) ephedrine use, (B) phenylephrine use, and (C) any vasopressor use with remimazolam anesthesia vs. sevoflurane anesthesia. OR, odds ratio; 95% CI, 95% confidence interval; PSM, propensity score matching. * p < 0.05 vs. sevoflurane group.

Figure 4

Intraoperative hemodynamic changes in the (A) mean blood pressure (MBP), (B) heart rate (HR), (C) cardiac index (CI), and (D) pulse-pressure variation (PPV). Values represent the estimated means from linear mixed models with standard error. PRE, pre-induction; Intu 10 min, 10 min after intubation; CO₂ ON, initiation of CO₂ pneumoperitoneum combined with head-up positioning; CO_{2 30min}, 30 min after initiation of CO₂ pneumoperitoneum; CO_{2 60min}, 60 min after initiation of CO₂ pneumoperitoneum; CO_{2 90min}, 90 min after initiation of CO₂ pneumoperitoneum; OP end, end of operation. * Bonferroni-corrected p < 0.05 vs. sevoflurane group.