Abstract

Hemodynamic instability, particularly hypotension, remains a significant concern during anesthesia induction in geriatric patients. This study compared the incidence and severity of post-induction hypotension between remimazolam and propofol in elderly patients undergoing sevoflurane-based general anesthesia with remifentanil. A prospective, randomized, double-blind study was conducted involving 180 patients aged ≥65 years scheduled for elective surgery under general anesthesia. Patients were randomly allocated to receive either remimazolam (0.3 mg/kg) or propofol (1.5 mg/kg) for anesthesia induction, followed by sevoflurane maintenance with remifentanil infusion. Primary outcome was the incidence of hypotension (systolic blood pressure <90 mmHg or >30% decrease from baseline) within 10 minutes post-induction. Secondary outcomes included hemodynamic parameters, vasopressor requirements, and adverse events. The incidence of post-induction hypotension was significantly lower in the remimazolam group compared to the propofol group (32.2% vs 57.8%, p<0.001). Mean arterial pressure decreased by 18.5±8.2% in the remimazolam group versus 28.7±11.4% in the propofol group (p<0.001). Vasopressor requirement was reduced by 40% in the remimazolam group. Time to loss of consciousness was comparable between groups (98±23 s vs 94±21 s, p=0.312). Remimazolam demonstrated superior hemodynamic stability compared to propofol during anesthesia induction in geriatric patients, with significantly reduced incidence of hypotension and vasopressor requirements while maintaining comparable efficacy.