Zhang YT, Bai SC. Effect of propofol and remimazolam on post-induction hypotension in hypertensive patients undergoing laparoscopic cholecystectomy. World J Gastrointest Surg 2026; 18(6): 120158 [DOI: 10.4240/wjgs.120158]
Corresponding Author of This Article
Shuan-Cheng Bai, Department of Anesthesiology, Affiliated Baotou Clinical College of Inner Mongolia Medical University, No. 61 Huancheng Road, Donghe District, Baotou 014040, Inner Mongolia Autonomous Region, China. bsc0130@163.com
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Zhang YT, Bai SC. Effect of propofol and remimazolam on post-induction hypotension in hypertensive patients undergoing laparoscopic cholecystectomy. World J Gastrointest Surg 2026; 18(6): 120158 [DOI: 10.4240/wjgs.120158]
World J Gastrointest Surg. Jun 27, 2026; 18(6): 120158 Published online Jun 27, 2026. doi: 10.4240/wjgs.120158
Effect of propofol and remimazolam on post-induction hypotension in hypertensive patients undergoing laparoscopic cholecystectomy
Yu-Ting Zhang, Shuan-Cheng Bai
Yu-Ting Zhang, Affiliated Baotou Clinical College of Inner Mongolia Medical University, Baotou 014040, Inner Mongolia Autonomous Region, China
Shuan-Cheng Bai, Department of Anesthesiology, Affiliated Baotou Clinical College of Inner Mongolia Medical University, Baotou 014040, Inner Mongolia Autonomous Region, China
Author contributions: Zhang YT and Bai SC conceived and designed the study; Zhang YT conducted the methodology and investigation and prepared the original draft of the manuscript; Bai SC contributed to the review and editing of the manuscript; Zhang YT was responsible for visualization, while Bai SC provided supervision; all authors have read and approved the final version of the manuscript.
Supported by the Zhongguancun Precision Medicine Foundation Project, No. 2024-1--097.
Institutional review board statement: Ethical approval for this study [Approval No. KYLL2024 (Ethics) 081] was obtained from the Ethics Committee of the Baotou Central Hospital.
Clinical trial registration statement: The trial was registered with the Clinical Trial Registry of China (ChiCTR2600117697).
Informed consent statement: All participants provided written informed consent.
Conflict-of-interest statement: The authors declare no competing interests.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: All patient data can be requested by sending an email to the corresponding author.
Corresponding author: Shuan-Cheng Bai, Department of Anesthesiology, Affiliated Baotou Clinical College of Inner Mongolia Medical University, No. 61 Huancheng Road, Donghe District, Baotou 014040, Inner Mongolia Autonomous Region, China. bsc0130@163.com
Received: February 24, 2026 Revised: March 5, 2026 Accepted: April 8, 2026 Published online: June 27, 2026 Processing time: 123 Days and 16.7 Hours
Abstract
BACKGROUND
Perioperative hemodynamic management is critical for patients with hypertension. Propofol, a commonly used intravenous anesthetic, is prone to inducing hypotension, while remimazolam may offer better hemodynamic stability.
AIM
To compare hypotension incidence and anesthetic effects of propofol vs remimazolam in hypertensive patients undergoing laparoscopic cholecystectomy.
METHODS
This randomized, single-blind trial compared remimazolam with propofol for total intravenous anaesthesia (TIVA) in hypertensive adults (n = 180) undergoing elective laparoscopic cholecystectomy between October 2024 and December 2025. The primary outcome was hypotension incidence after induction. Secondary outcomes included hemodynamic parameters, sedation onset, recovery time, adverse reactions, and postoperative recovery scores. The study was approved by the Ethics Committee of the Baotou Central Hospital and registered (ChiCTR2600117697).
RESULTS
The incidence of hypotension after induction was significantly lower in group R than in group P (40.91% vs 77.53%, P < 0.001), with reduced duration, time-weighted average, and norepinephrine usage (P < 0.001). At tracheal intubation and pneumoperitoneum establishment, group R had higher mean arterial pressure and heart rate than group P (P < 0.05). The time to Bispectral Index 60 and eyelash reflex loss was longer in group R (P < 0.001), but there was no significant difference in awakening and extubation times. Injection pain incidence during induction was lower in group R (2.27% vs 21.35%, P < 0.001). Group R also had significantly better early postoperative Riker Sedation-Agitation Scale scores (P < 0.001).
CONCLUSION
For hypertensive patients undergoing laparoscopic surgery, remimazolam TIVA is superior to propofol in reducing hypotension during induction, the need for vasoactive drugs, and the incidence of injection pain.
Core Tip: This study compared the incidence of post-induction hypotension (PIH) and hemodynamic stability between remimazolam and propofol during total intravenous anesthesia in hypertensive patients undergoing laparoscopic cholecystectomy. Compared to propofol, remimazolam significantly reduced the incidence and duration of PIH and decreased the use of norepinephrine. Remimazolam also had a lower incidence of injection pain during induction and better early postoperative sedation scores. The results suggest that remimazolam provides better hemodynamic stability without affecting the anesthetic effect, making it of high clinical value.
