Hemodynamic stability, less intraop hypotension risk with remimazolam in outpatient IR procedures

Editor's Note

New research indicates the anesthetic combination of remimazolam and fentanyl provides optimal hemodynamic stability for patients undergoing short outpatient interventional radiology (IR) procedures, Anesthesiology News July 16 reports. This study, presented at the 2024 annual meeting of the Society for Ambulatory Anesthesia, compared common anesthetic combinations at a freestanding ambulatory surgery center to assess relative safety.

Kara M. Barnett, MD, director of anesthesia services at Memorial Sloan Kettering Monmouth in New Jersey, told the outlet they began using remimazolam in a pilot program and observed “a lot of benefits in terms of hemodynamic stability,” particularly for sicker, older patients or those with respiratory concerns. After that, she noted they decided to compare the most common anesthetic combinations they had been using for IR to confirm the benefits of remimazolam.

The retrospective study analyzed 1,440 patients who underwent monitored anesthesia care (MAC) for outpatient IR procedures from January 4, 2021, to July 8, 2022. Patients were older than 18, and procedures lasted no more than 30 minutes. The five anesthetic combinations evaluated were:

• propofol-midazolam-fentanyl
• propofol-fentanyl
• propofol only
• midazolam-fentanyl
• remimazolam-fentanyl

The primary outcome measured was intraoperative hypotension (IOH), defined as either systolic blood pressure less than 90 mm Hg or mean arterial pressure less than 60 mm Hg. The study found the odds and duration of IOH varied based on the MAC combination used.

The remimazolam-fentanyl group exhibited the lowest rates of IOH and the least variability in duration. In contrast, the midazolam-fentanyl group had the most variable IOH and the highest median duration. Patients receiving propofol combinations experienced higher rates of intraoperative vasopressor use. Intraoperative bradycardia occurred in 1.5% of patients across all groups, with similar frequencies among the different combinations.

Dr Barnett emphasized that remimazolam might be more optimal for reducing the duration of IOH, which is crucial in minimizing hypotension. In the same article, Joanna Serafin, PhD, senior research scientist at Memorial Sloan Kettering Cancer Center’s Josie Robertson Surgery Center, highlighted that remimazolam could expedite recovery, making it a better option for some patients in outpatient settings.