# Safety and Efficacy of Remimazolam for General Anesthesia in Elderly Patients Undergoing Transurethral Surgery

## TL;DR

This study compares remimazolam and propofol for general anesthesia in elderly patients undergoing transurethral surgery, finding remimazolam safer with fewer hypotension issues but slower recovery.

## Contribution

The study provides new evidence on remimazolam's safety and efficacy compared to propofol in elderly urology patients.

## Key findings

- Remimazolam reduced hypotension occurrence and duration compared to propofol.
- Remimazolam caused higher rates of nausea, vomiting, and hiccups but shorter extubation time.
- Postoperative recovery quality was temporarily lower in the remimazolam group.

## Abstract

Remimazolam, a novel benzodiazepine, acts on the GABA receptor and is widely used for procedural sedation. To date, there are relatively few articles comparing remimazolam to propofol for general anesthesia in elderly urology patients. We compared the effectiveness and safety of remimazolam with flumazenil compared to propofol for general anesthesia in patients undergoing geriatric transurethral surgery.

Ninety‐six patients were randomly assigned to the propofol group (Group P) and the remimazolam group (Group R) from November 2021 to May 2022. The primary endpoints were the occurrence of hypotension during general anesthesia. The secondary outcomes included the success rate of sedation, intraoperative haemodynamic indices, perioperative inflammatory factor levels, quality of postoperative recovery, duration of extubation and PACU stay, and the incidence of adverse reactions in both groups.

Occurrence rate and duration of hypotension were lower in the remimazolam group (50% vs. 69.2%, p = 0.096; 0 [0,10] vs. 7.5 [1.24, 25]min, p = 0.008). Both groups could provide satisfactory sedation.

Remimazolam had less impact on hemodynamics during induction and intraoperative process. The remimazolam group had lower QoR‐15 scores on the first postoperative day, reflected in physical comfort and emotional state. The levels of IL‐6 and TNF‐α increased after surgery. In terms of adverse reactions, the incidence of nausea, vomiting, and hiccups in the remimazolam group was higher. Although the extubation time after antagonism in the remimazolam group was shorter, the time to reach the standard of leaving the post‐anesthesia care unit in the remimazolam group was longer than in the propofol group.

Remimazolam is both safe and effective for transurethral surgery in elderly patients. However, we need to be mindful of the need for monitoring after extubation and the possibility of a temporary reduction in the quality of recovery.