The purpose of this study is to compare two intravenous anesthetics, remimazolam and propofol, for their effects on intraoperative hemodynamic stability in patients undergoing thoracic or abdominal endovascular aortic repair. Maintaining blood pressure during these procedures is important to preserve organ perfusion, yet anesthetic-induced hypotension often requires vasopressor support. Since direct comparisons of these two anesthetics on hemodynamic outcomes in this population are limited, this randomized, single-blind, controlled trial will compare the intraoperative vasopressor requirement between the two groups to provide evidence for selecting a more hemodynamically stable anesthetic in these high-risk patients.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
44
* Continuous drug: remimazolam diluted to 2 mg/mL in normal saline * Induction: 6 mg/kg/h continuous infusion * Maintenance: 1-2 mg/kg/h (titrated to PSI 25-50, max 2 mg/kg/h) * Reversal at end of procedure: flumazenil 0.2-0.5 mg
* Continuous drug: propofol (undiluted, 20 mg/mL) * Administration: target-controlled infusion (TCI, Marsh model) * Induction: effect-site target concentration 4 μg/mL * Maintenance: 2-4 μg/mL (titrated to PSI 25-50)
Seoul National University Hospital
Seoul, South Korea
Time-weighted average (TWA) of the vasoactive-inotropic score (VIS)
Time-weighted average (TWA) of the vasoactive-inotropic score (VIS), calculated from the start of anesthetic administration to the start of hemostasis at the femoral access site. VIS reflects the cumulative dose of vasoactive and inotropic agents used to maintain target blood pressure during the procedure.
Time frame: From the start of anesthetic administration to the start of femoral access site hemostasis (intraoperative, up to 300 minutes)
Cumulative norepinephrine dosage
Cumulative norepinephrine dosage including bolus dose
Time frame: From the start of anesthetic administration to the start of femoral access site hemostasis (intraoperative, up to 300 minutes)
Peak VIS
Maximum VIS value recorded during the assessment period
Time frame: From the start of anesthetic administration to the start of femoral access site hemostasis (intraoperative, up to 300 minutes)
Time-weighted average of cumulative norepinephrine usage
Time-weighted average of cumulative norepinephrine usage including bolus dose
Time frame: From the start of anesthetic administration to the start of femoral access site hemostasis (intraoperative, up to 300 minutes)
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