Clinical comparative study of remimazolam tosilate and propofol on anesthesia effect in patients undergoing radical mastectomy

This study aims to compare the anesthetic effects of remimazolam tosilate and propofol in patients undergoing radical mastectomy. The study group received remimazolam tosilate in combination with sufentanil and cisatracurium besilate for anesthesia induction, while the control group received propofol with sufentanil and cisatracurium besilate. In the study group, the eyelash reflex disappearance time was longer and the recovery time was shorter compared to the control group (p < 0.05). No significant differences were observed in Post-Anesthesia Care Unit (PACU) retention time and Visual Analogue Scale (VAS) scores at 24 hours post-operation between the groups (p > 0.05). Furthermore, the study group exhibited a lower decrease in Mean Arterial Pressure (MAP) at 1, 3 and 5 minutes after anesthesia induction (p < 0.05). After losing consciousness, there was no statistically significant difference in HR decrease between both groups (p > 0.05). The study group also had higher respiratory rate (RR) and Tidal volume (VT) levels, with a lower incidence of apnea compared to the control group (p < 0.05). Thirty minutes before anesthesia, no significant differences were found in the five indicators between the groups (p > 0.05). At 24 hours post-operation, the study group showed higher Cluster of Differentiation 3+ (CD3+), CD4+, natural killer (NK) cell levels and CD4+/CD8+ ratios compared to the control group (p < 0.05). However, at 72 hours post-operation, no statistically significant differences were observed in these five indicators between the groups (p > 0.05). Compared with propofol, remimazolam tosilate achieves rapid sedation, maintains adequate sedation, and reduces suppression of the respiratory and circulatory systems.

Remimazolam tosilate; Propofol; Radical mastectomy; Anesthetic effect

[1] Li Z, Xia L, Li X, He H. Assessing the causality between thyroid and breast neoplasms: a bidirectional Mendelian randomization study. Frontiers in Oncology. 2022; 12: 973161.

[2] Pang QY, Duan LP, Jiang Y, Liu HL. Comparison of outcomes after breast cancer surgery between inhalational and propofol-based intravenous anaesthesia: a systematic review and meta-analysis. Journal of Pain Research. 2021; 14: 2165–2177.

[3] Aghamelu O, Buggy P, Smith G, Inzitari R, Wall T, Buggy DJ. Serum NETosis expression and recurrence risk after regional or volatile anaesthesia during breast cancer surgery: a pilot, prospective, randomised single‐blind clinical trial. Acta Anaesthesiologica Scandinavica. 2021; 65: 313–319.

[4] Murri A, Vitucci D, Tranchita E, Grazioli E, Gori S, Modena A, et al. “OPERATION PHALCO”—adapted physical activity for breast cancer survivors: is it time for a multidisciplinary approach? Cancers. 2022; 15: 34.

[5] Guo J, Qian Y, Zhang X, Han S, Shi Q, Xu J. Remimazolam tosilate compared with propofol for gastrointestinal endoscopy in elderly patients: a prospective, randomized and controlled study. BMC Anesthesiology. 2022; 22: 180.

[6] Liu M, Sun Y, Zhou L, Feng K, Wang T, Feng X. The median effective dose and bispectral index of remimazolam tosilate for anesthesia induction in elderly patients: an up-and-down sequential allocation trial. Clinical Interventions in Aging. 2022; 17: 837–843.

[7] Song X, Wang F, Dong R, Zhu K, Wang C. Efficacy and safety of remimazolam tosilate combined with esketamine for analgesic sedation in mechanically ventilated ICU patients: a single-arm clinical study protocol. Frontiers in Medicine. 2022; 9: 832105.

[8] Cao Y, Chi P, Zhou C, Lv W, Quan Z, Xue FS. Remimazolam tosilate sedation with adjuvant sufentanil in Chinese patients with liver cirrhosis undergoing gastroscopy: a randomized controlled study. Medical Science Monitor. 2022; 28: e936580.

[9] Tan Y, Ouyang W, Tang Y, Fang N, Fang C, Quan C. Effect of remimazolam tosilate on early cognitive function in elderly patients undergoing upper gastrointestinal endoscopy. Journal of Gastroenterology and Hepatology. 2022; 37: 576–583.

[10] Cao YH, Chi P, Zhou C, Lv WF, Quan ZF, Xue FS. The 50% and 95% effective doses of remimazolam tosilate with adjuvant sufentanil for sedation in patients with liver cirrhosis undergoing oesophagogastric varices screening endoscopy. Journal of Clinical Pharmacy and Therapeutics. 2022; 47: 2068–2073.

[11] Shi F, Chen Y, Li H, Zhang Y, Zhao T. Efficacy and safety of remimazolam tosilate versus propofol for general anesthesia in cirrhotic patients undergoing endoscopic variceal ligation. International Journal of General Medicine. 2022; 15: 583–591.

[12] Wang C, Gao Y, Li J, Zhang L, Li Q, Li Y, et al. Safety and effectiveness of the combination of remimazolam tosilate and propofol in gastroscopy: a multicenter, randomized controlled, single-blind clinical trial. Frontiers in Pharmacology. 2023; 14: 1124667.

[13] Chen X, Xin D, Xu G, Zhao J, Lv Q. The efficacy and safety of remimazolam tosilate versus dexmedetomidine in outpatients undergoing flexible bronchoscopy: a prospective, randomized, blind, non-inferiority trial. Frontiers in Pharmacology. 2022; 13: 902065.

[14] Luo W, Sun M, Wan J, Zhang Z, Huang J, Zhang J, et al. Efficacy and safety of remimazolam tosilate versus propofol in patients undergoing day surgery: a prospective randomized controlled trial. BMC Anesthesiol. 2023; 23: 182.

[15] Hu B, Jiang K, Shi W, Xiao S, Zhang S, Zhang Y, et al. Effect of remimazolam tosilate on respiratory depression in elderly patients undergoing gastroscopy: a multicentered, prospective, and randomized study. Drug Design, Development and Therapy. 2022; 16: 4151–4159.

[16] Hu B, Zhou H, Zou X, Tan L, Song T, Zellmer L, et al. Effect of remimazolam tosilate versus etomidate on hemodynamics in patients undergoing valve replacement surgery: study protocol for a randomized controlled trial. Trials. 2022; 23: 992.

[17] Liu F, Cheng X, Wang Y, Li K, Peng T, Fang N, et al. Effect of remimazolam tosilate on the incidence of hypoxemia in elderly patients undergoing gastrointestinal endoscopy: a bi-center, prospective, randomized controlled study. Frontiers in Pharmacology. 2023; 14: 1131391.

[18] Zhao TY, Chen D, Xu ZX, Wang HL, Sun H. Comparison of bispectral index and patient state index as measures of sedation depth during surgeries using remimazolam tosilate. BMC Anesthesiol. 2023; 23: 208.