Background: We aimed to evaluate whether the administration of remimazolam as a maintenance agent for general anesthesia affects the occurrence of hypotension compared with sevoflurane when switching to the beach chair position (BCP). Methods: We conducted a prospective randomized controlled trial from June 2023 to October 2023 in adult patients undergoing orthopedic surgery under general anesthesia in the BCP. A total of 78 participants were randomly allocated to the remimazolam (R) or sevoflurane (S) groups. The primary outcome was the incidence of hypotension that occurred immediately after switching to a BCP. The secondary outcomes included differences between the study groups in perioperative blood pressure (BP), heart rate (HR), endotracheal tube extubation time, postoperative complications, and hospital length of stay (LOS). Results: The incidence of hypotension immediately after switching to a BCP was significantly higher in the S group. The risk factors associated with hypotension included sevoflurane administration and a high baseline systolic BP. In the receiver operating characteristic curve analysis for the occurrence of hypotension after the transition to a BCP, the cutoff value for systolic BP was 142 mmHg. The perioperative BP and HR were higher in the R group at several timepoints. Postoperative endotracheal tube extubation time was shorter in the R group. There were no significant differences in the postoperative complications or hospital LOS between the two groups. Conclusions: Remimazolam should be considered as an anesthetic agent to prevent hypotension when switching to BCP, and hypotension may occur frequently in patients with high baseline BP.

中文翻译：

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沙滩椅位全身麻醉患者使用瑞马唑仑或七氟醚的血流动力学参数比较：单盲随机对照试验

背景：我们的目的是评估当切换到沙滩椅位置（BCP）时，与七氟醚相比，使用瑞马唑仑作为全身麻醉维持剂是否会影响低血压的发生。方法：我们于 2023 年 6 月至 2023 年 10 月对在 BCP 全身麻醉下接受骨科手术的成年患者进行了一项前瞻性随机对照试验。共有 78 名参与者被随机分配到瑞马唑仑 (R) 组或七氟醚 (S) 组。主要结局是改用 BCP 后立即发生低血压的发生率。次要结局包括研究组之间在围手术期血压（BP）、心率（HR）、气管插管拔管时间、术后并发症和住院时间（LOS）方面的差异。结果：S 组改用 BCP 后立即发生低血压的发生率显着较高。与低血压相关的危险因素包括七氟烷给药和高基线收缩压。在转为 BCP 后发生低血压的受试者工作特征曲线分析中，收缩压的临界值为 142 mmHg。 R 组在几个时间点的围手术期血压和心率较高。 R组术后气管插管拔管时间较短。两组术后并发症或住院LOS无显着差异。结论：改用 BCP 时应考虑使用瑞马唑仑作为麻醉剂来预防低血压，高基线血压患者可能经常发生低血压。