Wang QW, Wu L, Wang ZQ, Zhang J, Bai SC. Clinical application of remimazolam benzenesulfonate in elderly patients undergoing laparoscopic cholecystectomy under intravenous general anesthesia. World J Gastrointest Surg 2026; 18(7): 121776 [DOI: 10.4240/wjgs.v18.i7.121776]
Corresponding Author of This Article
Shuan-Cheng Bai, Full Professor, Affiliated Baotou Clinical College of Inner Mongolia Medical University, No. 61 Huancheng Road, Donghe District, Baotou 014040, Inner Mongolia Autonomous Region, China. 13947236426@163.com
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Wang QW, Wu L, Wang ZQ, Zhang J, Bai SC. Clinical application of remimazolam benzenesulfonate in elderly patients undergoing laparoscopic cholecystectomy under intravenous general anesthesia. World J Gastrointest Surg 2026; 18(7): 121776 [DOI: 10.4240/wjgs.v18.i7.121776]
World J Gastrointest Surg. Jul 27, 2026; 18(7): 121776 Published online Jul 27, 2026. doi: 10.4240/wjgs.v18.i7.121776
Clinical application of remimazolam benzenesulfonate in elderly patients undergoing laparoscopic cholecystectomy under intravenous general anesthesia
Qi-Wei Wang, Lan Wu, Zhi-Qiang Wang, Jia Zhang, Shuan-Cheng Bai
Qi-Wei Wang, Shuan-Cheng Bai, Affiliated Baotou Clinical College of Inner Mongolia Medical University, Baotou 014040, Inner Mongolia Autonomous Region, China
Lan Wu, Affiliated Inner Mongolia Clinical College of Inner Mongolia Medical University, Hohehot 010017, Inner Mongolia Autonomous Region, China
Zhi-Qiang Wang, Jia Zhang, Department of Anesthesiology, Baotou Central Hospital, Baotou 014040, Inner Mongolia Autonomous Region, China
Author contributions: Wang QW and Wu L conceived the study; Wang ZQ and Zhang J conducted the methodology and investigation, prepared the original draft of the manuscript, and performed the statistical analysis; Bai SC contributed to the review and editing of the manuscript.
Supported by Public Hospital Research Joint Fund Science and Technology Project, No. 2023GLLH0236.
Institutional review board statement: The study was approved by the Ethics Committee of Baotou Central Hospital [Approval No. KYLL2024(Ethics)082].
Clinical trial registration statement: This study is registered at https://www.chictr.org.cn/index.html. The registration identification number is ChiCTR2600117283.
Informed consent statement: All participants provided written informed consent. The study was conducted in accordance with the Declaration of Helsinki.
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, Full Professor, Affiliated Baotou Clinical College of Inner Mongolia Medical University, No. 61 Huancheng Road, Donghe District, Baotou 014040, Inner Mongolia Autonomous Region, China. 13947236426@163.com
Received: April 1, 2026 Revised: April 13, 2026 Accepted: May 14, 2026 Published online: July 27, 2026 Processing time: 117 Days and 20 Hours
Abstract
BACKGROUND
Elderly patients undergoing laparoscopic cholecystectomy (LC) are more vulnerable to hemodynamic instability and anesthesia-related adverse events. Remimazolam benzenesulfonate may be a useful alternative to propofol, but comparative evidence remains limited.
AIM
To compare the efficacy and safety of remimazolam benzenesulfonate and propofol in elderly patients undergoing LC.
METHODS
A total of 120 elderly patients scheduled for LC were randomized based on random number table and opaque sealed envelopes into 2 groups (n = 60 each): A propofol control group (CG) and a remimazolam benzenesulfonate observation group (OG). Anesthesia induction was intravenous propofol (1.5 mg/kg) or remimazolam benzenesulfonate (0.2 mg/kg), and rocuronium bromide (0.6 mg/kg) and sufentanil (0.4 ug/kg) in both groups. Anesthesia maintenance included targeted intravenous infusion of the assigned sedatives with remifentanil; intermittent rocuronium was used to keep a train-of-four ratio of ≤ 0.2. The primary outcome was mean arterial pressure (MAP). Secondary outcomes: Oxygen saturation, heart rate (HR), Bispectral index (BIS), perioperative use of vasoactive drugs, Riker Sedation-Agitation Scale (RSAS), Visual Analogue Scale (VAS), Mini Mental State Examination (MMSE), and incidence of adverse reactions.
RESULTS
After applying the predefined inclusion and exclusion criteria, 59 patients in both groups completed the trial. Relative to the CG, the OG had a longer induction time and delayed attainment of BIS < 60 (P < 0.05). However, the OG was found to have more stable MAP and HR throughout the perioperative period, lower consumption of vasoactive agents, and fewer adverse events (P < 0.05). Post-extubation RSAS scores were also lower in the OG (P < 0.05). Postoperatively, the OG had greater MMSE scores at 6 hours and lower VAS pain scores at 1 hour and 6 hours (P < 0.05). No significant variances between groups were revealed at other time points.
CONCLUSION
Relative to propofol, remimazolam benzenesulfonate has more stable hemodynamics and a lower incidence of adverse reactions during total intravenous anesthesia in elderly patients undergoing LC. While remimazolam showed benefits in early postoperative recovery, cognitive function, and pain control, these benefits were lost over time.
Core Tip: This study demonstrates that remimazolam benzenesulfonate offers more stable hemodynamics and a lower incidence of adverse reactions compared to propofol during total intravenous anesthesia in elderly patients undergoing laparoscopic cholecystectomy. Additionally, remimazolam provides benefits in early postoperative recovery, cognitive function, and pain control, though these advantages diminish over time. These findings suggest that remimazolam may be a promising alternative for anesthesia management in this patient population.
