REmimazolam vs Propofol Total Intravenous Anesthesia on Outcomes After Major Noncardiac SurgEry

Inclusion Criteria: * Age ≥45 years; * Undergoing elective major surgery under general anesthesia (expected surgery time \>2 h, expected length of postoperative stay \>2 d); * Fulfilling ≥1 of the following criteria: 1. history of coronary artery disease; 2. history of stroke; 3. history of congestive heart failure; 4. preoperative NT-proBNP \>200 pg/mL or BNP\>92 pg/mL; 5. age ≥70 years; 6. diabetes requiring medical treatment; 7. ASA status 3 or 4; 8. history of chronic kidney disease (preoperative sCr \>133 μmol/L or 1.5 mg/dL); 9. history of peripheral arterial disease; 10. preoperative serum albumin \<30 g/L; 11. preoperative hemoglobin \<100 g/L. Exclusion Criteria: * Undergoing organ transplantation, cardiac, craniocerebral, burn or interventional operations; * Low risk or minor surgery * End-stage renal disease requiring renal-replacement therapy; * Hepatic dysfunction (Child B or C); * Previous liver or kidney transplantation; * Previous allergy to general anesthetics; * Unable to receive bispectral index monitoring; * ASA score ≥5; * Exposure to general anesthesia in prior 30 days or anticipated re-exposure to general anesthesia within 30 days after surgery; * Need for prolonged airway protection or mechanical ventilatory support after surgery; * Current participation in another interventional study; * Previous participation in this study; * Pregnant or breastfeeding women.