Cardioprotective effects of remimazolam in elderly hypertensive patients undergoing gastrointestinal tumor surgery: A randomized controlled trial

doi:10.4251/wjgo.v18.i8.121785

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Randomized Controlled Trial

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Oncol. Aug 15, 2026; 18(8): 121785
Published online Aug 15, 2026. doi: 10.4251/wjgo.v18.i8.121785

Table 1 Comparison of baseline characteristics between the two groups, mean ± SD/n (%)

Item	P group (n = 40)	R group (n = 40)	χ²/t value	P value
Sex			2.650	0.104
Male	29 (72.50)	22 (55.00)
Female	11 (27.50)	18 (45.00)
Age (years)	73.90 ± 8.03	70.83 ± 6.70	1.859	0.067
ASA classification			2.257	0.133
II	8 (20.00)	14 (35.00)
III	32 (80.00)	26 (65.00)
Height (cm)	165.98 ± 6.73	164.73 ± 6.72	0.831	0.409
Weight (kg)	64.46 ± 9.59	64.74 ± 10.41	-0.123	0.903
BMI (kg/m²)	23.30 ± 2.99	23.80 ± 3.25	-0.713	0.478
Tumor type			5.137	0.162
Colon cancer	11 (27.50)	20 (50.00)
Rectal cancer	13 (32.50)	8 (20.00)
Gastric cancer	15 (37.50)	12 (30.00)
Gastrointestinal stromal tumor	1 (2.50)	0 (0.00)
Comorbidities
Cerebral infarction	7 (17.50)	4 (10.00)	0.949	0.330
Diabetes mellitus	6 (15.00)	10 (25.00)	1.250	0.264
Coronary heart disease	2 (5.00)	1 (2.50)	0.000	1.000
Others	5 (12.50)	3 (7.50)	0.139	0.709

P group: Control group (propofol-based intravenous general anesthesia); R group: Experimental group (remimazolam-based intravenous general anesthesia); ASA: American Society of Anesthesiologists; BMI: Body mass index.

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Table 2 Comparison of perioperative serum biomarkers of myocardial injury between the two groups, mean ± SD

Item	Time	P group (n = 40)	R group (n = 40)	t value	P value
hs-cTn (ng/mL)	T0	11.73 ± 14.55	13.15 ± 5.83	-0.575	0.567
	T8	14.73 ± 6.73	10.25 ± 4.55^a	3.483	< 0.001
CK (U/L)	T0	31.96 ± 18.41	56.40 ± 47.37	-3.042	0.003
	T8	68.87 ± 63.87^a	63.24 ± 84.49	0.336	0.738
CK-MB (U/L)	T0	8.41 ± 5.09	6.69 ± 4.36	1.626	0.108
	T8	10.21 ± 5.83^a	5.54 ± 3.27	4.417	< 0.001
LDH (U/L)	T0	186.87 ± 76.69	190.21 ± 59.56	-0.218	0.828
	T8	210.09 ± 88.78^a	179.52 ± 52.75	1.873	0.065
AST (U/L)	T0	23.81 ± 14.79	26.54 ± 35.80	-0.445	0.657
	T8	27.09 ± 16.79	21.62 ± 9.54	1.794	0.077
NT-proBNP (pg/mL)	T0	147.60 ± 144.07	142.56 ± 152.48	0.152	0.880
	T8	490.16 ± 328.72^a	285.00 ± 239.52^a	3.190	0.002

^aP < 0.05 vs T0.

hs-cTn: High-Sensitivity Troponin; CK: Creatine kinase; CK-MB: Creatine kinase-MB; LDH: Lactate dehydrogenase; AST: Aspartate aminotransferase; NT-proBNP: N-terminal pro-brain natriuretic peptide; P group: Control group (propofol-based intravenous general anesthesia); R group: Experimental group (remimazolam-based intravenous general anesthesia).

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Table 3 Comparison of arterial blood gas parameters between the two groups, mean ± SD

Item	Time	P group (n = 40)	R group (n = 40)	t value	P value
SBP (mmHg)	T0	157.00 ± 19.34	153.58 ± 17.32	0.834	0.407
	T6	145.30 ± 18.10^a	144.08 ± 17.91^a	0.304	0.762
DBP (mmHg)	T0	79.88 ± 13.60	80.10 ± 10.80	-0.082	0.935
	T6	76.48 ± 10.29	73.58 ± 9.41^a	1.316	0.192
HR (bpm)	T0	74.28 ± 11.33	72.43 ± 12.78	0.685	0.495
	T6	72.85 ± 13.01	72.05 ± 11.19	0.295	0.769
Glu (mmol/L)	T0	6.16 ± 1.36	6.28 ± 1.95	-0.321	0.749
	T4	6.91 ± 1.34^a	7.32 ± 1.77^a	-1.170	0.245
Lac (mmol/L)	T0	1.08 ± 0.53	0.84 ± 0.28	2.507	0.014
	T4	0.80 ± 0.36^a	0.68 ± 0.29^a	1.714	0.091
PaCO₂ (mmHg)	T0	40.11 ± 6.27	42.29 ± 5.88	-1.608	0.112
	T4	48.34 ± 7.05^a	46.22 ± 5.56^a	1.488	0.141

^aP < 0.05 vs T0.

SBP: Systolic blood pressure; DBP: Diastolic blood pressure; HR: Heart rate; Glu: Glucose; Lac: Lactate; PaCO₂: Partial pressure of carbon dioxide; P group: Control group (propofol-based intravenous general anesthesia); R group: Experimental group (remimazolam-based intravenous general anesthesia).

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Table 4 Comparison of postoperative pain between the two groups, mean ± SD

Time	P group (n = 40)	R group (n = 40)	t value	P value
T6	0.45 ± 0.88	0.43 ± 0.96	0.122	0.903
T7	3.38 ± 1.44^a	2.65 ± 1.44^a	2.247	0.028
T8	2.28 ± 1.11^a^,^b	1.20 ± 0.88^a^,^b	4.796	< 0.001

^aP < 0.05 vs T6 within the same group.

^bP < 0.05 vs T7 within the same group.

P group: Control group (propofol-based intravenous general anesthesia); R group: Experimental group (remimazolam-based intravenous general anesthesia).

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Table 5 Comparison of postoperative complication rates between the two groups, n (%)

Item	P group (n = 40)	R group (n = 40)	χ²/t value	P value
Postoperative agitation score, median (IQR)	1.00 (1.00-2.00)	2.00 (2.00-3.00)	-5.12	< 0.001
Postoperative agitation	24 (60.00)	4 (10.00)	21.978	< 0.001
Delayed recovery	0 (0.00)	0 (0.00)
Postoperative delirium	1 (2.50)	0 (0.00)	0	1
Hypoxemia	0 (0.00)	0 (0.00)
Nausea and vomiting	5 (12.50)	8 (20.00)	0.827	0.363
MINS	18 (45.00)	6 (15.00)	8.571	0.003

IQR: Interquartile range; MINS: Myocardial injury after non-cardiac surgery; P group: Control group (propofol-based intravenous general anesthesia); R group: Experimental group (remimazolam-based intravenous general anesthesia).

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Table 6 Comparison of intraoperative parameters between the two groups, mean ± SD

Item	P group (n = 40)	R group (n = 40)	t value	P value
Operative time (minute)	176.25 ± 55.42	163.38 ± 57.07	1.024	0.309
Intraoperative fluid volume (mL)	1530.00 ± 316.19	1462.50 ± 327.92	0.937	0.352
Colloid volume (mL)	153.75 ± 230.77	287.50 ± 250.32	-2.485	0.015
Crystalloid volume (mL)	1376.25 ± 301.70	1175.00 ± 401.12	2.536	0.013
Intraoperative blood loss (mL)	56.00 ± 50.32	49.75 ± 25.77	0.699	0.487
Intraoperative transfusion (mL)	7.50 ± 47.43	15.00 ± 66.22	-0.582	0.562
Urine output (mL)	335.25 ± 146.71	316.25 ± 129.29	0.615	0.541
Norepinephrine consumption (μg)	354.00 ± 509.58	37.70 ± 80.77	3.877	< 0.001
Extubation time (minute)	16.35 ± 11.34	14.08 ± 7.56	1.056	0.294
PACU stay (minute)	45.00 ± 11.82	44.75 ± 11.09	0.098	0.923
Postoperative hospital stay (day)	12.53 ± 3.00	11.55 ± 2.02	1.702	0.093

PACU: Post-anesthesia care unit; P group: Control group (propofol-based intravenous general anesthesia); R group: Experimental group (remimazolam-based intravenous general anesthesia).

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Table 7 Comparison of 30-day adverse events between the two groups, n (%)

Item	P group (n = 40)	R group (n = 40)	Fisher’s exact test	P value
Pulmonary infection	1 (2.50)	0 (0.00)
Incision infection	2 (5.00)	1 (2.50)
Cerebral infarction	1 (2.50)	0 (0.00)
Loss of appetite	1 (0.00)	1 (2.50)
Intestinal obstruction	0 (0.00)	2 (5.00)
Total adverse events	5 (12.50)	4 (10.00)	0.000	1.000

P group: Control group (propofol-based intravenous general anesthesia); R group: Experimental group (remimazolam-based intravenous general anesthesia).

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Table 8 Comparison of baseline characteristics between non-myocardial injury after non-cardiac surgery and myocardial injury after non-cardiac surgery patients, mean ± SD/n (%)

Item	Non-MINS group (n = 56)	MINS group (n = 24)	χ²/t value	P value
Sex			1.878	0.171
Male	33 (58.93)	18 (75.00)
Female	23 (41.07)	6 (25.00)
Age (years)	71.96 ± 7.45	73.29 ± 7.74	-0.722	0.472
ASA classification			2.018	0.155
II	18 (32.14)	4 (16.67)
III	38 (67.86)	20 (83.33)
Height (cm)	165.27 ± 6.66	165.54 ± 6.98	-0.166	0.869
Weight (kg)	64.79 ± 9.57	64.17 ± 10.99	0.254	0.801
BMI (kg/m²)	23.70 ± 3.16	23.21 ± 3.06	0.634	0.528
Tumor type			13.582	0.004
Colon cancer	28 (50.00)	3 (12.50)
Rectal cancer	10 (17.86)	11 (45.83)
Gastric cancer	18 (32.14)	9 (37.50)
Gastrointestinal stromal tumor	0 (0.00)	1 (4.17)
Comorbidities
Cerebral infarction	10 (17.86)	1 (4.17)	1.626	0.202
Diabetes mellitus	10 (17.86)	6 (25.00)	0.182	0.669
Coronary heart disease	2 (3.57)	1 (4.17)	0.000	1.000
Others	5 (8.93)	3 (12.50)	0.007	0.935
Anesthesia strategy			8.571	0.003
Conventional general anesthesia (P group)	22 (39.29)	18 (75.00)
General anesthesia + remimazolam (R group)	34 (60.71)	6 (25.00)

MINS: Myocardial injury after non-cardiac surgery; P group: Control group (propofol-based intravenous general anesthesia); R group: Experimental group (remimazolam-based intravenous general anesthesia); ASA: American Society of Anesthesiologists; BMI: Body mass index.

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Table 9 Comparison of perioperative serum biomarkers of myocardial injury between non-myocardial injury after non-cardiac surgery and myocardial injury after non-cardiac surgery patients, mean ± SD

Item	Time	Non-MINS group (n = 56)	MINS group (n = 24)	t value	P value
hs-cTn (ng/mL)	T0	12.38 ± 12.40	12.58 ± 7.11	-0.077	0.939
	T8	10.80 ± 6.03	16.42 ± 4.42	-4.108	< 0.001
CK (U/L)	T0	44.52 ± 39.38	43.39 ± 34.49	0.121	0.904
	T8	58.66 ± 60.17	83.31 ± 99.74	-1.364	0.176
CK-MB (U/L)	T0	7.15 ± 4.40	8.51 ± 5.58	-1.167	0.247
	T8	7.07 ± 5.03	9.74 ± 5.39	-2.133	0.036
LDH (U/L)	T0	192.13 ± 73.07	180.15 ± 55.89	0.717	0.475
	T8	189.93 ± 75.86	206.18 ± 70.29	-0.897	0.372
AST (U/L)	T0	26.25 ± 30.89	22.66 ± 16.09	0.538	0.592
	T8	23.65 ± 10.89	26.00 ± 19.26	-0.692	0.491
NT-proBNP (pg/mL)	T0	139.27 ± 154.79	158.64 ± 130.65	-0.536	0.593
	T8	334.21 ± 286.67	512.11 ± 312.21	-2.477	0.015

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Table 10 Comparison of arterial blood gas parameters between non-myocardial injury after non-cardiac surgery and myocardial injury after non-cardiac surgery patients, mean ± SD

Item	Time	Non-MINS group (n = 56)	MINS group (n = 24)	t value	P value
SBP (mmHg)	T0	155.93 ± 20.05	153.79 ± 13.73	0.476	0.636
	T6	143.61 ± 16.41	147.21 ± 21.15	-0.823	0.413
DBP (mmHg)	T0	79.61 ± 12.38	80.88 ± 11.99	-0.424	0.673
	T6	74.27 ± 10.48	76.79 ± 8.34	-1.045	0.299
HR (bpm)	T0	73.86 ± 11.17	72.17 ± 14.04	0.573	0.568
	T6	72.73 ± 11.95	71.79 ± 12.56	0.318	0.752
Glu (mmol/L)	T0	6.11 ± 1.54	6.47 ± 1.96	-0.891	0.376
	T4	7.16 ± 1.68	7.01 ± 1.32	0.401	0.689
Lac (mmol/L)	T0	0.99 ± 0.44	0.88 ± 0.44	1.022	0.310
	T4	0.74 ± 0.33	0.73 ± 0.33	0.117	0.907
PaCO₂ (mmHg)	T0	41.14 ± 5.69	41.33 ± 7.22	-0.121	0.904
	T4	47.20 ± 6.24	47.46 ± 6.88	-0.163	0.871

SBP: Systolic blood pressure; DBP: Diastolic blood pressure; HR: Heart rate; Glu: Glucose; Lac: Lactate; PaCO₂: Partial pressure of carbon dioxide; MINS: Myocardial injury after non-cardiac surgery.

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Table 11 Comparison of surgical indicators between non-myocardial injury after non-cardiac surgery and myocardial injury after non-cardiac surgery patients, mean ± SD

Item	Non-MINS group (n = 56)	MINS group (n = 24)	t value	P value
Operative time (minute)	159.64 ± 44.09	193.54 ± 73.40	-2.554	0.013
Intraoperative fluid volume (mL)	1484.82 ± 286.34	1522.92 ± 398.36	-0.483	0.631
Colloid volume (mL)	252.68 ± 250.35	145.83 ± 232.15	1.787	0.078
Crystalloid volume (mL)	1232.14 ± 315.71	1377.08 ± 456.83	-1.636	0.106
Intraoperative blood loss (mL)	50.71 ± 40.40	57.92 ± 38.90	-0.739	0.462
Intraoperative transfusion (mL)	10.71 ± 56.18	12.50 ± 61.24	-0.127	0.899
Urine output (mL)	310.89 ± 112.61	360.42 ± 181.77	-1.485	0.142
Norepinephrine consumption (μg)	172.89 ± 429.37	249.42 ± 305.35	-0.790	0.432
Extubation time (minute)	14.93 ± 9.15	15.88 ± 10.90	-0.400	0.690
PACU stay (minute)	43.93 ± 11.07	47.08 ± 12.06	-1.137	0.259
Postoperative hospital stay (day)	11.70 ± 2.21	12.83 ± 3.24	-1.824	0.072

PACU: Post-anesthesia care unit; MINS: Myocardial injury after non-cardiac surgery.

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Table 12 Multivariable logistic regression analysis of factors associated with myocardial injury after non-cardiac surgery

Variable	B	SE	Wald χ² value	P value	OR	95%CI
Variable	B	SE	Wald χ² value	P value	OR	Lower	Upper
Tumor type
Rectal cancer	4.281	1.675	6.534	0.011	72.348	2.714	1928.285
Gastric cancer	3.650	1.526	5.723	0.017	38.475	1.934	765.444
Gastrointestinal stromal tumor	24.031		0.000	1.000		0.000
Anesthesia method
General anesthesia + remimazolam (R group)	-3.188	1.305	5.972	0.015	0.041	0.003	0.532
hs-cTn
T6	-0.105	0.094	1.250	0.263	0.900	0.749	1.082
T7	0.285	0.176	2.624	0.105	1.330	0.942	1.877
T8	-0.041	0.181	0.050	0.823	0.960	0.674	1.368
CK-MB
T6	0.225	0.137	2.699	0.100	1.252	0.958	1.638
T7	-0.001	0.107	0.000	0.989	0.999	0.810	1.230
T8	-0.152	0.140	1.182	0.277	0.859	0.652	1.130
NT-proBNP
T6	-0.004	0.004	1.313	0.252	0.996	0.988	1.003
T7	0.011	0.004	8.340	0.004	1.011	1.004	1.019
T8	-0.009	0.004	5.380	0.020	0.991	0.984	0.999
Operation time	0.015	0.008	3.060	0.080	1.015	0.998	1.032
Constant	-9.040	2.599	12.102	< 0.001	0.000

OR: Odds ratio; CI: Confidence interval; hs-cTn: High-Sensitivity Troponin; CK-MB: Creatine kinase-MB; NT-proBNP: N-terminal pro-brain natriuretic peptide; R group: Experimental group (remimazolam-based intravenous general anesthesia).

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Table 13 Receiver operating characteristic curve parameters of the predictive model for myocardial injury after non-cardiac surgery in elderly patients with hypertension undergoing gastrointestinal tumor surgery

Variable	AUC	95%CI		^aP value	Cut-off	Sensitivity (%)	Specificity (%)
Variable	AUC	Lower	Upper	^aP value	Cut-off	Sensitivity (%)	Specificity (%)
Tumor type	0.658^b	0.543	0.760	0.012	Non-colon cancer	87.50	50.00
Anesthesia method	0.679	0.565	0.779	0.006	General anesthesia + remimazolam	75.00	60.71
NT-proBNP at T7	0.680	0.567	0.780	0.007	647.2 pg/mL	54.17	80.36
NT-proBNP at T8	0.704	0.592	0.801	0.001	412.6 pg/mL	58.33	76.79
MINS predictive model	0.765	0.656	0.852	< 0.001		91.67	50.00

^aP < 0.05 vs the reference line (area under the curve = 0.500).

^bP < 0.05 vs the myocardial injury after non-cardiac surgery predictive model.

AUC: Area under the curve; CI: Confidence interval; NT-proBNP: N-terminal pro-brain natriuretic peptide; MINS: Myocardial injury after non-cardiac surgery.

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Citation: Ma TT, Tong J, Liu MY. Cardioprotective effects of remimazolam in elderly hypertensive patients undergoing gastrointestinal tumor surgery: A randomized controlled trial. World J Gastrointest Oncol 2026; 18(8): 121785
URL: https://www.wjgnet.com/1948-5204/full/v18/i8/121785.htm
DOI: https://dx.doi.org/10.4251/wjgo.v18.i8.121785

Ma TT, Tong J, Liu MY. Cardioprotective effects of remimazolam in elderly hypertensive patients undergoing gastrointestinal tumor surgery: A randomized controlled trial. World J Gastrointest Oncol 2026; 18(8): 121785 [DOI: 10.4251/wjgo.v18.i8.121785]

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