Published online Aug 15, 2026. doi: 10.4251/wjgo.v18.i8.121785
Revised: May 7, 2026
Accepted: May 26, 2026
Published online: August 15, 2026
Processing time: 115 Days and 0.6 Hours
Elderly patients with hypertension undergoing gastrointestinal tumor surgery are at increased risk of perioperative cardiovascular complications, particularly myocardial injury after non-cardiac surgery (MINS). Anesthetic management plays a crucial role in maintaining hemodynamic stability and reducing cardiac stress in this vulnerable population. Remimazolam, a novel ultra-short-acting benzodiazepine, has shown potential advantages in cardiovascular stability compared with conventional anesthetic agents; however, its cardioprotective effects in high-risk surgical patients remain insufficiently explored.
To evaluate the cardioprotective effects and safety of remimazolam-based general anesthesia compared with conventional anesthesia in elderly hypertensive patients undergoing gastrointestinal tumor surgery, with a particular focus on myocardial injury markers, hemodynamic stability, postoperative recovery, and the incidence of MINS.
A total of 80 elderly hypertensive patients who underwent gastrointestinal tumor surgery at Yizheng Hospital of Nanjing Drum Tower Hospital Group between April 2024 and August 2025 were selected. Patients were randomly divided into a control group (P group) and an experimental group (R group) using the envelope method. P group received conventional general anesthesia, while R group received remimazolam-based general anesthesia. Perioperative serum biomarkers, arterial blood gas indices, postoperative pain, incidence of postoperative complications, surgical indicators, and adverse events within 30 days of follow-up were compared between the two groups. Patients were further divided into non-MINS and MINS groups based on the occurrence of MINS. Differences in clinical indicators between the two groups were analyzed. Binary logistic regression was used to identify risk factors for MINS, and a predictive model was constructed and validated based on these factors.
At T0, creatine kinase (CK) levels were significantly lower and lactate levels significantly higher in P group compared with R group (P < 0.05). At T1, systolic and diastolic blood pressures were significantly lower in P group than in R group (P < 0.05). At T6, CK-MB levels were significantly higher in P group (P < 0.05). At T7, High-Sensitivity Troponin (hs-cTn), CK-MB, and aspartate aminotransferase were significantly higher in P group (P < 0.05). At T8, CK-MB and N-terminal pro-brain natriuretic peptide (NT-proBNP) were significantly higher in P group (P < 0.05). Visual Analog Scale scores at T7 and T8 were significantly higher in P group (P < 0.05). Postoperative agitation scores and incidence were significantly higher in P group (P < 0.05), as was the incidence of MINS (P < 0.05). Intraoperatively, colloid use was significantly lower, while crystalloid and norepinephrine use were significantly higher in P group (P < 0.05). There was no significant difference in the incidence of adverse events within 30 days postoperatively between the two groups (P > 0.05). Compared with the MINS group, the non-MINS group had significantly lower proportions of colon cancer and conventional general anesthesia, as well as lower levels of hs-cTn, CK-MB, NT-proBNP at T6-T8, and shorter operative time (P < 0.05). Multivariate analysis showed that tumor type, anesthesia method, NT-proBNP at T7, and NT-proBNP at T8 were independent risk factors for MINS. The area under the curve for NT-proBNP at T8 and the predictive model was > 0.7.
The use of remimazolam for general anesthesia in elderly hypertensive patients undergoing gastrointestinal tumor surgery can reduce myocardial injury and the incidence of MINS. It helps stabilize perioperative blood pressure, alleviates postoperative pain, reduces the risk of postoperative agitation, and decreases intraoperative nore
Core Tip: This randomized controlled study demonstrates that remimazolam-based anesthesia provides significant cardioprotective effects in elderly hypertensive patients undergoing gastrointestinal tumor surgery. Compared with conventional anesthesia, remimazolam reduces cardiac biomarker levels, improves hemodynamic stability, alleviates postoperative pain and agitation, and lowers the incidence of myocardial injury after non-cardiac surgery. These findings suggest that remimazolam may be a safer anesthetic option in high-risk elderly populations and highlight potential strategies for preventing perioperative cardiac complications.