To evaluate whether remimazolam-based general anesthesia reduces perioperative vasopressor burden and improves hemodynamic stability and postoperative outcomes compared with propofol induction followed by volatile maintenance in patients with abdominal sepsis.
Approach:
Study Design: Retrospective single-center study analyzing 220 patients with Sepsis-3 undergoing abdominal surgery from January 2021 to June 2025, using a prospectively maintained database.
Patient Groups: Patients were categorized into two groups: propofol/volatile anesthesia (Group C, n = 116) and remimazolam induction and maintenance (Group R, n = 104).
Outcomes Measured: Primary outcome was the Vasopressor-Inotrope Score (VIS) at ICU admission; secondary outcomes included intraoperative hemodynamics, change in Sequential Organ Failure Assessment, ICU/hospital length of stay, mortality, and complications.
Key Findings:
Lower VIS at ICU admission with remimazolam (P = 0.006) in a matched cohort (87 per group).
Shorter ICU LOS with remimazolam (P = 0.008).
Shorter hospital LOS with remimazolam (P = 0.012).
Lower in-hospital mortality with remimazolam (P = 0.007).
Fewer hospital-acquired infections with remimazolam (P = 0.048).
No differences in mechanical ventilation duration, 30-day mortality, acute kidney injury, acute respiratory distress syndrome, delirium, major complications, or ICU readmission.
Interpretation:
Remimazolam-based anesthesia was associated with greater hemodynamic stability and reduced postoperative vasopressor needs, suggesting lower resource utilization and in-hospital mortality in septic surgical patients.
Limitations:
Retrospective design may introduce bias.
Single-center study limits generalizability.
Potential confounding factors not fully controlled.
Conclusion:
Further prospective trials are warranted to establish causality regarding the effects of remimazolam-based anesthesia on outcomes in septic patients undergoing surgery.
