Hypotension incidence comparison between remimazolam and propofol in hypertensive patients undergoing spinal surgery

OBJECTIVES: This study aimed to compare the incidence of hypotension between remimazolam and propofol in hypertensive patients undergoing spinal surgery. METHODS: We conducted a retrospective analysis of 194 hypertensive patients who received either remimazolam (n=99) or propofol (n=95) as the primary anesthetic during spinal surgery under general anesthesia. Hemodynamic parameters and bispectral index (BIS) were continuously monitored. The primary outcome was the incidence of intraoperative hypotension, defined as a mean arterial pressure (MAP) below 80% of baseline within 13 minutes of drug administration. Severe hypotension was defined as MAP below 70% of baseline. Postoperative adverse events, including postoperative nausea and vomiting (PONV), injection pain, dizziness, delirium, and hypoxemia, were also recorded. RESULTS: The incidence of hypotension was significantly lower in the remimazolam group compared to the propofol group (82.83% vs. 93.68%, P=0.019). The remimazolam group demonstrated more stable MAP at key time points (5-12 minutes post-induction) and a lower incidence of PONV (15.15% vs. 29.47%, P=0.016) and injection pain (2.02% vs. 26.32%, P