Objective To observe the effects of remimazolam,cipepofol,and propofol on hemodynamics,blood glucose,and lactate levels during general anesthesia induction.Methods A total of 126 elective surgery patients at the Second Affiliated Hospital of Nanjing Medical University from August to November 2023,undergoing non-cardiothoracic and neurosurgical procedures under general anesthesia,were included.Patients were randomly assigned using a random number table into three groups:remimazolam group,cipepofol group,and propofol group,with 42 patients in each group.Anesthesia induction included intravenous sufentanil 0.2-0.3 μg/kg followed by administration of the study drugs:remimazolam group received remimazolam 0.3 mg/kg,cipepofol group received cipepofol 0.4 mg/kg(0.3 mg/kg for patients over 70 years),and propofol group received propofol 2.0 mg/kg(1.5 mg/kg for patients over 70 years).Rocuronium 0.6 mg/kg was injected after loss of eyelash reflex,followed by placement of a laryngeal mask for ventilation control.Heart rate(HR),mean arterial pressure(MAP),and bispectral index(BIS)values were recorded at upon entry(T0),before intubation(T,),immediately after intubation(T2),and 3 minutes after intubation(T3).Blood glucose and lactate levels were recorded at T1 and T3.Incidence of injection pain,hypotension,bradycardia,hiccup,agitation during emergence,patient satisfaction upon leaving the recovery room,intraoperative awareness,postoperative dizziness,nausea,and vomiting were also documented.Results A total of 42 cases were included in the remimazolam group,36 cases in the cipepofol group,and 39 cases in the propofol group.The incidence of hypotension during induction was 9 cases(21％)in the remimazolam group,15 cases(42％)in the cipepofol group,and 21 cases(54％)in the propofol group,and the difference among three groups was significant(x2=9.204,P=0.010).The remimazolam group had a significantly lower incidence of hypotension compared to the propofol group(P＜0.017).Bradycardia during induction occurred in 6 cases(14％)in the remimazolam group,18 cases(50％)in the cipepofol group,and 12 cases(31％)in the propofol group,with significant difference among three groups(x2=11.607,P=0.003).The remimazolam group had a significantly lower incidence of bradycardia compared to the cipepofol group(P＜0.017).Multivariate analysis indicated that the remimazolam was an independent protective factor against hypotension(OR=0.199,95％CI:0.073-0.549,P=0.002)and bradycardia(OR=0.173,95％CI:0.057-0.520,P=0.002)during induction.There was statistically significant difference in the incidence of injection pain among the remimazolam group,cipepofol group,and propofol group(14％vs 0 vs 54％,x2=33.429,P＜0.001).Conclusion Remimazolam,cipepofol,and propofol can be used for anesthesia induction.Propofol could induce hypotension,while propofol notably induces bradycardia.Remimazolam acts as an independent protective factor against hypotension and bradycardia during induction.
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