Effect of remimazolam versus propofol on inferior vena cava collapse index during general anesthesia induction: a randomized controlled trial

Background: This study was aimed to evaluate the effect of remimazolam compared to propofol on the inferior vena cava collapse index (IVC-CI) during general anesthesia induction. Methods: A total of 60 patients were randomly assigned to receive remimazolam (0.3 mg/kg; n = 30) or propofol (2–2.5 mg/kg; n = 30). IVC-CI was the primary outcome after induction. The recorded secondary outcomes included maximum and minimum diameters of inferior vena cava (dIVCmax and dIVCmin, respectively), mean arterial pressure (MAP), heart rate (HR), bispectral index (BIS), and adverse events. Results: Among 60 patients, 59 were evaluable for the outcomes (1 canceled surgery). After administering the anesthesia, mean IVC-CI was 25.5% in remimazolam group vs. 26.1% in propofol group (adjusted mean difference, −0.6% (95% confidence interval (CI), −4.5 to 3.3), p = 0.755); mean dIVCmin was 1.26 mm vs. 1.30 mm (adjusted mean difference, 0 (95% CI, −0.12 to 0.13), p = 0.960); mean dIVCmax was 1.71 mm vs. 1.77 mm (adjusted mean difference, −0.04 (95% CI, −0.21 to 0.14), p = 0.693); mean MAP was 81.4 mmHg vs. 75.5 mmHg (adjusted mean difference, 5.6 mmHg (95% CI, 1.8 to 9.3), p = 0.005); mean HR was 77.7 bpm vs. 69.3 bpm (adjusted mean difference, 7.9 bpm (95% CI, 5.2 to 10.6), p < 0.001); and mean BIS was 55.6 vs. 54.0, respectively (adjusted mean difference, 1.7 (95% CI, −1.0 to 4.4), p = 0.215). Hypotension was recorded in 2 (6.7%) vs. 9 (31.0%) (p = 0.016), while injection pain in 0 vs. 11 (37.9%) (p < 0.001). There was no agitation, bradycardia, reflux aspiration or bronchospasm. Conclusions: The remimazolam usage for anesthesia induction did not significantly reduce the IVC-CI compared to propofol. Clinical Trial Registration: The study was registered on www.chictr.org.cn (ChiCTR2300070911).

Remimazolam; Propofol; Hypotension; Inferior vena cava ultrasound

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