Effect of propofol and remimazolam on post-induction hypotension in hypertensive patients undergoing laparoscopic cholecystectomy

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.

Key Words: Remimazolam; Propofol; Total intravenous anesthesia; Hypertensive patients; Laparoscopic cholecystectomy

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.

INTRODUCTION

As the world population is gradually aging, hypertension has become a significant issue. The prevalence of hypertension among people aged 30-79 years has increased by about 650 million to almost 1.3 billion[1]. It is common to find that patients with hypertension have less vascular compliance, impaired autonomic control, and that they are more dependent on sufficient perfusion of vital organs. Such physiological changes make them more prone to major changes in hemodynamics during anesthesia induction and surgery. Additionally, hypertensive patients are at an increased risk of perioperative complications such as cardiac events, bleeding, renal failure, and postoperative infections by a significant margin, in comparison to normotensive patients. The perioperative risk in hypertensive patients is still high even in case of the successful management of blood pressure with pharmacological therapy[2-5]. Thus, the challenge of ensuring hemodynamic stability with a sufficient depth of anesthesia in hypertensive patients is one of the most important issues in the anesthetic care of hypertensive patients.

Total intravenous anaesthesia (TIVA) has become a common clinical practice because it has a high level of controllability of anesthetic depth and an excellent recovery profile. Propofol is an agent that is frequently used in TIVA, and it has the benefits of quick onset and consistent sedative effects. Nonetheless, its dose-related myocardial depression and peripheral vasodilation often lead to hypotension during induction of anesthesia and the initial part of the operation. This is more acute in patients with hypertension where hemodynamic support may require the administration of vasoactive agents[6].

Remimazolam is a new ultra-short-acting benzodiazepine intravenous anesthetic, with rapid onset, high clearance, and hepatic and renal independent metabolism. Remimazolam has a comparatively weak depressive impact on the cardiovascular system when compared to propofol and has been used more and more frequently in the induction and maintenance of general anesthesia over the past years. Past research indicates that remimazolam has the potential of minimizing cases of perioperative hypotension in general and high-risk groups. Nevertheless, in the case of the targeted group of hypertension patients, the evidence of prospective randomized studies on the comparative anesthetic performance and hypotension rates of remimazolam and propofol in TIVA is not adequate[7].

Hence, the research design used in this study was a prospective, randomized, single-blind study that compared the anesthetic effect and occurrence of perioperative hypotension between remimazolam and propofol in TIVA in hypertensive patients with the view to offering clinical evidence in order to inform the rational use of perioperative anesthetic agents in this cohort.

MATERIALS AND METHODS

Study subjects and general information

This was a prospective randomized single-blind controlled trial. One hundred and eighty hypertensive patients that had an elective laparoscopic cholecystectomy at our hospital between October 2024 and December 2025 were enrolled. A random number table was generated using a computer and the patients were randomly allocated to either the propofol group (group P) or the remimazolam group (group R) with 90 patients each. Every patient was in sufficient control of blood pressure before surgery as per the institutional perioperative requirements. The protocol of the study was approved by the Ethics Committee of the Baotou Central Hospital [Approval No. KYLL2024 (Ethics) 081] and registered in the Chinese Clinical Trial Registry (ChiCTR2600117697). All participants gave informed consent in writing. The research was done according to the Declaration of Helsinki, and the paper is written in line with the Consolidated Standards of Reporting Trials principles. Group P lost one patient during the study period because of the inability to perform postoperative extubation, which necessitated admission to the intensive care unit. Group R had one patient who was converted to open surgery during the operation and another refused to receive follow-up after the operation. Finally, 89 patients in group P and 88 patients in group R passed through the study and were incorporated in the final analysis.

Inclusion criteria: (1) Patients aged 18-85 years; (2) A known diagnosis of hypertension; (3) Physical status II-III according to the American Society of Anesthesiologists (ASA); (4) Written informed consent to participate; and (5) A body mass index (BMI) of 18.5-30 kg/m².

Exclusion criteria: (1) ASA physical status ≥ IV; (2) Allergy to the study drugs; (3) Mental conditions that do not allow cooperation with the study procedures; (4) Laparoscopic to open conversion; (5) Respiratory tract infection in the 2 weeks before surgery; and (6) Severe hepatic/renal dysfunction.

Randomization and blinding

Patients were allocated to either group R or group P using a random number table generated by an independent investigator who was not involved in anesthesia management or outcome assessment. Due to differences in drug formulation and administration characteristics, the attending anesthesiologists were not blinded. However, patients, postoperative data collectors, and statistical analysts were blinded to group allocation, and the study therefore adopted a single-blind design with blinded outcome assessment.

Sample size estimation

The incidence of post-induction hypotension (PIH) was the primary outcome measure. According to the previous literature and the results of the pre-experiment, the incidence of PIH in group R was 33% lower than that in group P[8]. The sample size calculation was performed using PASS 11.0 software, assuming an effect size of 0.33 between the two groups, with α = 0.05 and a test power (1 - β) of 0.80. Based on these parameters, the software calculated that at least 80 samples per group were required. Considering the possibility of dropout or incomplete data, 90 patients were ultimately included in each group.

Anesthesia method

When patients were taken into the operating room, they were regularly observed using electrocardiography, pulse oximetry [oxygen saturation (SpO₂)], and noninvasive blood pressure and intravenous access was established. Oxygen supplementation was through face mask.

Anesthesia induction: Group R: Remimazolam was used to induce anesthesia. Group P: Propofol was used to induce anesthesia. Group P: Propofol was infused intravenously at 1.0-1.5 mg/kg, at a rate of 60 mg/kg/hour. Remimazolam was used in group R, at a rate of 0.15-0.2 mg/kg, intravenously, and infused at 6 mg/kg/hour. After the eyelash reflex of the patient had disappeared and the patient was not responding to light pinprick or shaking, the two groups were given 0.4 μg/kg sufentanil and 0.6 mg/kg rocuronium bromide intravenously. Intubation of the trachea was done 90 seconds after the administration of rocuronium, upon the loss of eyelash reflex and a Bispectral Index (BIS) of ≤ 60.

Maintenance of anesthesia: TIVA was used to maintain anesthesia in the two groups. The given sedative agent was introduced as a continuous intravenous infusion immediately after the induction to ensure a proper depth of anesthesia. Group P propofol was infused at 6-12 mg/kg/hour and group R remimazolam infused at 0.5-1.0 mg/kg/hour. The BIS was kept within the range of 40-60, and the dosage of anesthetic was changed based on the hemodynamic variations. Norepinephrine was given intravenously in the case of intraoperative hypotension using a standardized protocol with continuous infusion used in severe cases. The relaxation of the muscle was also sustained through periodic administration of rocuronium bromide (0.1-0.2 mg/kg).

At the end of the surgery, the infusion of anesthetic drugs was stopped, and a mixture of neostigmine (0.04 mg/kg) and atropine (0.02 mg/kg) was administered to reverse the degree of muscle relaxation. The patient was extubated after spontaneous breathing, coughing and swallowing reflexes were restored and the patient could respond to instructions. After extubation, the patient was transferred to the recovery room. The patients were then discharged to the post-anesthesia care unit. All patients were given intravenous analgesia (PCIA) that was patient controlled using a combination of hydromorphone (10 mg) and metoclopramide (30 mg) in 100 mL of 0.9% sodium chloride. The PCIA parameters were 2 mL/hour background infusion rate, 0.5 mL bolus dose and 15 minutes lockout.

Observation indicators

Primary outcome: The incidence of hypotension from the induction of anesthesia to the time when the scalpel touches the skin [defined as mean arterial pressure (MAP) < 65 mmHg or a decrease of ≥ 30% from the baseline value]; the time to reach a BIS value of 60 after anesthesia.

Secondary outcome measures: (1) Time-weighted average of hypotension, total duration of hypotension, and total amount of vasoactive drugs used during the period from anesthesia induction to skin incision; (2) Compare the time of loss of eyelash reflex, the time of awakening (the time from the end of drug administration to the patient's verbal prompt to open the eyes), and the time of extubation (the time from the end of drug administration to the removal of the tracheal intubation) between the two groups during the induction period; (3) Heart rate (HR), MAP, BIS, and blood SpO₂ were recorded before anesthesia (T0), after anesthesia induction (T1), at intubation (T2), at the establishment of pneumoperitoneum (T3), 30 minutes after the start of surgery (T4), and at extubation (T5); (4) The side effects of the two groups were observed, including pain during induction injection, bradycardia, hemodynamic hyperreactivity, defined as an increase of 30% in systolic blood pressure compared with the baseline during anesthesia induction, hypoxemia, allergic reaction, dizziness/headache, drowsiness and delirium; (5) The Riker Sedation-Agitation Scale (RSAS) was used to assess the sedation effect at 1 minute, 15 minutes and 30 minutes after extubation, with a score of 1-7; and (6) The Quality of Recovery Score (QoR-15) recovery quality score was used to evaluate the recovery quality of the two groups of patients at 6 hours, 12 hours and 24 hours after surgery.

Statistical analysis

Data analysis was done with SPSS version 26.0. Kolmogorov-Smirnoff test was used to determine the normality of the continuous variables. Variables that are normally distributed are represented in the form of mean ± SD. In the case of normally distributed variables that have equal variance, the independent-samples t-test was applied to compare two independent groups. Two-way repeated-measures analysis of variance (ANOVA) was used to test the main effects of group and time and their interaction, which are repeated-measures variables. Sphericity test was carried out by Mauchly before the analysis and Greenhouse-Geisser correction was used in case the assumption of sphericity was not met. In case of a significant interaction effect, simple effects were further examined and post hoc pairwise comparisons were corrected with Bonferonni correction. The frequencies or percentages are used to present the categorical variables and the χ²-test or Fisher exact test is used to compare the variables. The P value of < 0.05 was regarded as statistically significant. Numbers were created with GraphPad Prism version 8.0, and the tendencies of repeated-measures variables were represented in the form of line graphs.

RESULTS

Comparison of general data of the two groups of patients

The 180 patients were randomized. After exclusion, 88 patients in group R and 89 patients in group P were involved in the final analysis. Baseline demographic or clinical characteristics (sex, age, BMI, ASA physical status), duration of hypertension, preoperative blood pressure, antihypertensive medication use, and surgical duration or intraoperative blood loss did not have any statistically significant differences between the two groups (all P > 0.05; Table 1).

Table 1 Comparison of general data between the two groups of patients, n (%)/mean ± SD.

Variable	Remimazolam group (n = 88)	Propofol group (n = 89)	t/χ2 value	P value
Male	46 (52.27)	45 (50.56)	0.051	0.882
Age (year)	65.92 ± 8.15	66.45 ± 7.89	0.418	0.677
BMI (kg/m2)	24.58 ± 3.02	24.92 ± 2.95	0.736	0.462
ASA classification (II/III)	64/24	66/23	0.156	0.925
Diabetes	22(25.00)	25(28.09)	0.321	0.572
Type of antihypertensive drugs
ACEI/ARB	65 (73.86)	74 (83.15)	0.233	0.233
CCB	32 (36.36)	42 (47.19)	0.173	0.173
Diuretic	20 (22.73)	18 (20.22)	0.666	0.666
Others	2 (2.27)	3 (3.37)	0.667	0.667
Duration of hypertension (year)	8.65 ± 3.22	8.98 ± 3.45	0.762	0.447
Preoperative systolic pressure (mmHg)	139.65 ± 10.32	139.91 ± 9.87	0.385	0.700
Preoperative diastolic pressure (mmHg)	88.36 ± 6.21	87.92 ± 5.98	0.452	0.652
Surgical duration (minute)	58.12 ± 11.65	58.89 ± 12.03	0.436	0.663
Intraoperative blood loss (mL)	14.89 ± 8.35	15.76 ± 8.12	0.568	0.570

BMI: Body mass index; ASA: American Society of Anesthesiologists; ACEI: Angiotensin-converting enzyme inhibitor; ARB: Angiotensin receptor blocker; CCB: Calcium channel blocker.

Comparison of postoperative anesthesia and recovery between the two groups

The incidence of PIH was significantly lower in group R than in group P (40.91% vs 77.53%, P < 0.001). The time-weighted average of hypotension was lower in group R than in group P [0.00 (0.00, 0.71) vs 0.55 (0.00, 4.68), P < 0.001], as was the total duration of hypotension [0.00 (0.00, 5.00) vs 3.00 (0.00, 8.00), P < 0.001]. In addition, total norepinephrine consumption between induction and skin incision was significantly reduced in group R compared with group P [0.00 (0.00, 16.00) vs 14.00 (0.00, 28.00), P < 0.001; Table 2].

Table 2 Comparison of postoperative anesthesia and recovery between the two groups, n (%)/mean ± SD/median (interquartile range).

Variable	Remimazolam group (n = 88)	Propofol group (n = 89)	Statistic	P value
Post-induction hypotension incidence	36 (40.91)	69 (77.53)	15.286	< 0.001
Time to reach BIS 60 (second)	77.65 ± 8.02	59.89 ± 6.15	14.892	< 0.001
Time to loss of eyelash reflex (second)	51.36 ± 8.89	34.65 ± 7.58	13.258	< 0.001
Recovery time (second)	508.45 ± 52.23	517.92 ± 58.11	1.786	0.076
Extubation time (second)	541.12 ± 52.75	564.68 ± 62.59	1.352	0.178
Time-weighted average of hypotension (mmHg)	0.00 (0.00, 0.71)	0.55 (0.00, 4.68)	-5.123	< 0.001
Total duration of hypotension (minute)	0.00 (0.00, 5.00)	3.00 (0.00, 8.00)	-5.234	< 0.001
Total norepinephrine use after induction (μg)	0.00 (0.00, 16.00)	14.00 (0.00, 28.00)	-5.567	< 0.001

BIS: Bispectral Index.

Vital signs and the BIS in both groups changed over time during anesthesia induction and surgery. There were no statistically significant differences in baseline hemodynamic parameters between the two groups before surgery. Compared with the propofol group, the remimazolam group showed a significantly higher HR at T3 (71.02 ± 6.45 vs 65.43 ± 7.23, P < 0.05). MAP was higher in the remimazolam group than in the propofol group at T1, T2, and T3 (85.41 ± 8.23 vs 80.35 ± 9.34, 84.72 ± 7.56 vs 75.87 ± 6.78, and 88.98 ± 5.34 vs 81.92 ± 8.12, respectively; all P < 0.05). Additionally, BIS values were significantly higher in the remimazolam group from T2 to T4 compared with the propofol group (59.02 ± 8.12 vs 54.79 ± 8.89, 55.64 ± 8.34 vs 50.76 ± 9.56, and 56.94 ± 9.56 vs 50.83 ± 10.34, respectively; all P < 0.05; Figure 1).

Figure 1 Comparison of perioperative heart rate, mean arterial pressure, Bispectral Index, and oxygen saturation between the two groups. A-D: Heart rate (A), mean arterial pressure (B), oxygen saturation (C), and Bispectral Index (D) comparison between remimazolam and propofol. HR: Heart rate; MAP: Mean arterial pressure; BIS: Bispectral Index; SpO₂: Oxygen saturation.

Comparison of the incidence of adverse reactions between the two groups

The incidence of pain during induction injection in the R group was significantly lower than that in the P group (P < 0.001), and there was no difference in the incidence of other adverse reactions between the two groups (P > 0.05; Table 3).

Table 3 Comparison of the incidence of adverse reactions between the two groups, n (%).

Adverse event	Remimazolam group (n = 88)	Propofol group (n = 89)	χ2 value	P value
Injection pain during induction	2 (2.27)	19 (21.35)	15.398	< 0.001
Bradycardia (HR < 50 beats/minute)	3 (3.41)	5 (5.62)	0.500	0.479
Nausea and vomiting	2 (2.27)	4 (4.49)	0.667	0.414
Hypoxemia (SpO2 < 95%)	2 (2.27)	3 (3.37)	0.194	0.659

HR: Heart rate; SpO₂: Oxygen saturation.

Comparison of RSAS and QoR-15 scores at different time points after extubation between the two groups

The RSAS score of the remimazolam group was significantly lower than that of the propofol group 1 minute after extubation (4.12 ± 0.43 vs 4.88 ± 0.91, P < 0.001). Similarly, at 15 minutes and 30 after extubation, the RSAS score of the remimazolam group remained significantly lower than that of the propofol group (P < 0.001).

The QoR-15 score results showed that the R group was better than the P group in the score values at 6 hours, 12 hours and 24 hours after surgery, but the difference was not statistically significant (Table 4).

Table 4 Comparison of Quality of Recovery Score and Riker Sedation-Agitation Scale scores at different time points after surgery in the two groups of patients, mean ± SD.

Time point	Remimazolam group (n = 88)	Propofol group (n = 89)	Statistic	P value
RSAS score
1 minute after extubation	4.12 ± 0.43	4.88 ± 0.91	-7.121	< 0.001
15 minutes after extubation	4.04 ± 0.32	4.92 ± 0.58	-12.525	< 0.001
30 minutes after extubation	4.06 ± 0.24	4.98 ± 0.47	-14.174	< 0.001
QoR-15 score
6 hours after surgery	104.62 ± 8.37	102.74 ± 10.16	1.751	0.152
12 hours after surgery	114.34 ± 8.94	112.47 ± 9.68	1.421	0.163
24 hours after surgery	118.53 ± 7.58	116.84 ± 8.26	1.377	0.172

RSAS: Riker Sedation-Agitation Scale; QoR-15: Quality of Recovery Score.

DISCUSSION

This prospective, randomized, single-blind study systematically compared remimazolam and propofol for TIVA in hypertensive patients undergoing laparoscopic cholecystectomy. The findings demonstrated that remimazolam was significantly superior to propofol in reducing the incidence and severity of PIH, and decreasing vasopressor requirements. In contrast, propofol exhibited a more rapid onset of sedation.

During the stimulus-free phase from anesthetic induction to the start of surgery, the myocardial depressant effects of anesthetic agents are compounded by the absence of surgical stimulation. Even when a moderate depth of anesthesia is maintained, this may lead to a further decrease in blood pressure. Such induction-phase hypotension is more common and more harmful in patients with hypertension, which may be related to impaired autonomic regulation, reduced baroreflex sensitivity, and increased vascular stiffness inherent to this population[9,10]. Previous studies in painless gastrointestinal endoscopy have shown that remimazolam maintains hemodynamic stability better than propofol[11]. Similarly, in anesthesia for living-donor kidney transplantation, remimazolam has been shown to have less impact on renal function and to be associated with milder intraoperative blood pressure fluctuations[12]. However, whether remimazolam provides the same benefits in hypertensive patients undergoing total intravenous anesthesia remains insufficiently studied; therefore, we conducted the present study. Our results showed that the incidence of hypotension from after anesthetic induction to before the start of surgery was significantly lower in the remimazolam group (40.91%) than in the propofol group (77.53%). In addition, the duration and severity of hypotension, as well as the dose of norepinephrine required, were all markedly reduced in the remimazolam group. We also analyzed hemodynamic parameters at specific time points. At T2 and T3, both MAP and HR were lower in the propofol group than in the remimazolam group. At T4, no significant differences in MAP or HR were observed between the two groups, which may be attributable to the corrective effects of vasopressor use. These findings are highly consistent with previous reports[13,14]. The underlying mechanisms are likely closely related to the pharmacological differences between the two agents. Patients with hypertension often have impaired autonomic regulation, decreased baroreflex sensitivity, and reduced vascular compliance, making them less tolerant of anesthesia-related vasodilation and myocardial depression. Propofol mainly enhances the function of GABA receptors in a non-specific manner, resulting in dose-dependent peripheral vasodilation, reduced venous return, and direct myocardial inhibition, which makes it easier to cause a sudden drop in blood pressure and insufficient compensation in this population[15]. In contrast, remimazolam, as a new benzodiazepine drug, can selectively act on the α1 subunit of the GABA receptor, and has a lighter inhibitory effect on peripheral vascular tension and myocardial contraction function. It also retains the baroreceptor reflex and sympathetic nerve compensation ability to a certain extent, thus reflecting its hemodynamic advantages in the anesthesia of hypertensive patients[16,17].

In this study, the time to reach BIS 60 and loss of eyelash reflex in the remimazolam group was significantly longer than that in the propofol group, reflecting its relatively slow onset. This seems to be related to the differences in the lipid solubility and pharmacokinetics of the two drugs: Propofol has high lipid solubility and can quickly pass thru the blood-brain barrier, and it has a fast onset; remimazolam is a water-soluble preparation, and the penetration speed of the blood-brain barrier is slow[7]. However, there was no statistically significant difference in the time to awakening and extubation between the two groups, suggesting that although remimazolam has a slow onset, it has a rapid awakening. This feature is due to its rapid metabolism into inactive products thru tissue non-specific esterase, high clearance rate, and non-dependence on liver and kidney function, and it is not easy to accumulate[18]. It is worth noting that when comparing the recovery time of remimazolam and propofol, if flumazenil is routinely used for antagonism, the comparison of the natural recovery process of the two may be confused. Therefore, flumazenil was not routinely used in this study, which can more truly reflect the metabolic recovery characteristics of remimazolam.

In this study, the incidence of injection pain during the induction period in the remimazolam group was significantly lower than that in the propofol group, which was related to its water-soluble preparation characteristics, avoiding the stimulation of lipid excipients in propofol emulsion to blood vessels[7]. Early postoperative sedation assessment showed that the Riker sedation-agitation score of the remimazolam group was closer to the ideal level, suggesting that the recovery process was more stable, which may be related to the more stable hemodynamics and lighter stress response during the operation. Regarding the postoperative RSAS scores, we found that the remimazolam group had lower RSAS scores, which is consistent with previous studies[19]. This may be attributed to the mechanism of remimazolam, whereby its sedative effect is significantly potentiated by concomitant use with opioid analgesics. Additionally, propofol directly acts on the transient receptor potential channels at nerve endings, promoting vasodilation and increased permeability, thereby causing sensitization of the dorsal root ganglion and peripheral nerves, which enhances pain perception[19]. The quality of postoperative recovery measured with the QoR-15 scale did not differ statistically significantly between the groups, but remimazolam was numerically better. Recent research shows that remimazolam has no inferiority over propofol in terms of quality of postoperative recovery[20]. The reported numerical superiority can be associated with the more stable hemodynamic profile and anti-inflammatory effects of remimazolam that might lead to decreased systemic stress and inflammation, which, in turn, might be related to the better postoperative recovery[21].

There are also some limitations in this study. First, due to the differences in dosage forms and administration methods of the study drugs, the anesthesiologists failed to achieve complete blinding, which may lead to a certain degree of implementation bias. Second, this study is a single-center study with a relatively limited sample size, and the extrapolation of the study conclusions is relatively limited. In addition, this study mainly focused on preoperative hypotension and early postoperative related indicators, and has not conducted long-term follow-up observations on the long-term postoperative cognitive function changes, cardiovascular events and other outcomes. Future research can be further expanded from the following aspects: First, conduct multi-center, randomized, double-blind clinical trials to more comprehensively evaluate the safety and effectiveness of remimazolam in patients with hypertension and different types of surgery; Second, systematically explore the synergistic effect of remimazolam in combination with different analgesic drugs (such as alfentanil and sufentanil) to optimize individualized anesthesia regimens.

CONCLUSION

In conclusion, remimazolam, when used for total intravenous anesthesia in laparoscopic surgery for hypertensive patients, offers significant advantages in reducing anesthesia induction hypotension, decreasing the use of vasoactive drugs, and lowering the incidence of injection pain. Furthermore, it does not compromise the quality of early postoperative recovery.