The use of remimazolam versus propofol for anesthesia induction in video-assisted thoracoscopic surgery: study protocol for a multicenter randomized controlled trial

May 26, 2025Trials

Comparing remimazolam and propofol for starting anesthesia in minimally invasive lung surgery

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Abstract

A total of 172 patients will be evaluated for hypotension within 20 minutes after anesthesia induction using either remimazolam or propofol.

Intraoperative hypotension is linked to increased risks of postoperative complications such as myocardial injury and acute kidney injury.
More than half of intraoperative hypotension incidents occur immediately after the induction of general anesthesia.
Propofol, commonly used for anesthesia induction, can cause hemodynamic instability, leading to adverse outcomes.
Remimazolam, an ultra-short-acting intravenous sedative-hypnotic, may offer more stable hemodynamics compared to propofol.
Previous studies suggest remimazolam is associated with a lower incidence of hypotension than propofol.

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BACKGROUND: Intraoperative hypotension may result in a higher incidence of postoperative myocardial injury, acute kidney injury, and stroke. Notably, more than half of intraoperative hypotension cases occur immediately after induction of general anesthesia. Although intraoperative hypotension has multiple causes, post-induction hypotension is primarily due to the effects of anesthetic drugs. Propofol is the most widely used agent for anesthesia induction. However, propofol can induce hemodynamic instability, potentially leading to adverse postoperative outcomes. Remimazolam, a novel ultra-short-acting intravenous sedative-hypnotic, may promote stable hemodynamics. Studies have reported that remimazolam is associated with less hypotension compared to propofol. Therefore, this study aims to compare the hemodynamic effects of remimazolam and propofol during anesthesia induction in patients undergoing video-assisted thoracoscopic surgery.

METHODS: This is a prospective, multicenter randomized controlled trial. A total of 172 patients aged 45 to 65 years undergoing video-assisted thoracoscopic surgery will be randomly allocated to receive remimazolam or propofol during anesthetic induction. The primary outcome is the incidence of hypotension occurring within 20 min after anesthesia induction. Hypotension is defined as systolic blood pressure (SBP) of less than 90 mmHg, or a reduction of more than 30% in SBP from baseline, or the administration of vasoactive medication. Secondary outcomes include the rate of successful sedation, time to successful sedation, coughing during the induction period, postoperative delirium within 7 days after surgery, and postoperative in-hospital mortality.

DISCUSSION: To date, remimazolam has rarely been used for anesthesia induction in video-assisted thoracoscopic surgery. This study will provide important information on hemodynamic stability and anesthesia efficacy of remimazolam in this surgical setting.

TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2400085556. Registered on 12 th June 2024, http://www.chictr.org.cn/ .

Key numbers

172

Sample Size

Patients aged 45 to 65 years undergoing thoracoscopic surgery.

50%

Incidence of Hypotension

Estimated incidence of hypotension based on previous studies.

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The use of remimazolam versus propofol for anesthesia induction in video-assisted thoracoscopic surgery: study protocol for a multicenter randomized controlled trial

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