Blood Pressure Reduction During Anesthetic Induction with Remimazolam versus
Propofol in Elderly Patients: Pharmacodynamic Modeling of Remimazolam
#MMPMID41180601
Oh J
; Kim KM
; Sim JH
; Lee EK
; Choi BM
Drug Des Devel Ther
2025[]; 19
(?): 9571-9580
PMID41180601
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PURPOSE: Remimazolam, a novel hypnotic agent, has demonstrated superior
hemodynamic stability compared with propofol during general anesthesia,
particularly in elderly patients. However, the dose-dependent reduction in blood
pressure associated with remimazolam has not been quantitatively modeled in this
population. PATIENTS AND METHODS: We analyzed data from 432 patients aged ? 65
years who underwent elective gastrectomy as part of a randomized trial comparing
remimazolam with propofol. Remimazolam was administered via zero-order infusion
at 6 mg/kg/h, whereas propofol was delivered using target-controlled infusion
(TCI) guided by the Schnider model. Blood pressure data were transformed into
fractional changes in mean arterial pressure (MBP) relative to baseline. A
modified simple logistic regression model was developed to characterize the
relationship between cumulative remimazolam dose and MBP reduction, with body
weight evaluated as a covariate. RESULTS: A total of 209 patients were analyzed
in each group. The modified logistic model effectively described the
dose-dependent MBP reduction associated with remimazolam. Body weight was
identified as a significant covariate that improved model performance. Although
the remimazolam group exhibited a statistically greater MBP reduction before
intubation than the propofol group (28.0?±?9.9% vs 25.8?±?10.1% reduction from
baseline, P?=?0.024), the difference was not considered clinically meaningful.
CONCLUSION: In elderly patients undergoing general anesthesia with remimazolam,
the relationship between dose and MBP reduction during induction was well
characterized using a modified logistic model, with body weight as a significant
covariate. TCI may represent an effective dosing strategy for maintaining
hemodynamic stability during anesthetic induction. TRIAL REGISTRATION: This study
was registered at the Clinical Research Information Service of the Korean
National Institute of Health (CRIS, http://cris.nih.go.kr), with registration
number KCT0006877, on December 27, 2021.
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