Effects of different doses of remimazolam on the quality of sedation and cardiac function in elderly patients: a double-blind randomised controlled study

Background: We intended to observe the effects of different doses of remimazolam besylate via intravenous induction on the quality of sedation and cardiac function in elderly patients.

Methods: A total of 135 ASA I-III patients undergoing elective laparoscopic cholecystectomy were selected. They were divided into three groups and they were randomized. Low dose group (Group L): Remimazolam besylate 0.2 mg/kg; middle dose group (Group M): Remimazolam besylate 0.3 mg/kg; High dose group (Group H): Remimazolam besylate 0.4 mg/kg. There were 45 patients in each group. The blood pressure, heart rate, BIS values, cardiac function before induction (T₀), after induction (T₁) and after intubation (T₂), as well as the length of loss of consciousness, duration of sedation, and extubation and adverse events were recorded.

Results: At T₁ and T₂, systolic and diastolic blood pressure in Group M were lower than those in Group L, but higher than those in Group H, with statistically significant differences (P < 0.05). At T₁ and T₂, the BIS value in Group M was lower than that in Group L, with a statistically significant difference (P < 0.05). However, there was no statistically significant difference (P > 0.05) in BIS values between Group M and Group H; At T₁ and T₂, the cardiac output and stroke volume in Group M were higher than those in Group H, while the systemic vascular resistance in Group M was lower than that in Group H, with statistically significant differences (P < 0.05); The incidences of bucking when moving and hiccup in Group L were higher than those in Group M and Group H, with statistically significant differences (P < 0.05). The number of vasoactive drugs used in Group H was higher than that in Group L and Group M, with statistically significant differences (P < 0.05).

Conclusions: General anesthesia induction with remimazolam besylate at 0.3 mg/kg in elderly patients undergoing laparoscopic cholecystectomy showed good quality of sedation, could achieve rapid intubation, with minimal effect on cardiac function and generally favorable safety profile.