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Volume 61
Issue 9
10.3390/medicina61091721
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Article

Comparative Effects of Remimazolam and Propofol on Intraoperative Hypertension and Hypotension During Robot-Assisted Laparoscopic Gynecologic Surgery: A Retrospective Analysis

by
Jung Min Lee
1,
Joohyun Lee
1,*,
Se Hee Kang
1,2,
Kangha Jung
1,
Hyean Yeo
1 and
Young Joo
1
1
Department of Anesthesiology and Pain Medicine, CHA Ilsan Medical Center, CHA University, Goyang-si 10414, Republic of Korea
2
Department of Anesthesiology and Pain Medicine, College of Medicine, Kangwon National University, Chuncheon 24341, Republic of Korea
*
Author to whom correspondence should be addressed.
Medicina 2025, 61(9), 1721; https://doi.org/10.3390/medicina61091721
Submission received: 14 August 2025 / Revised: 17 September 2025 / Accepted: 19 September 2025 / Published: 22 September 2025
(This article belongs to the Section Intensive Care/ Anesthesiology)
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Abstract

Background and Objectives: Remimazolam is a recently introduced benzodiazepine that has been increasingly adopted as an alternative to propofol. Although several trials have compared remimazolam with propofol, these studies have primarily focused on induction-related hypotension in non-gynecologic settings. To the best of our knowledge, both intraoperative hypertension and hypotension have not been systematically evaluated throughout the full anesthetic course in the specific physiologic context of robot-assisted laparoscopic gynecologic surgery performed in the steep Trendelenburg position with pneumoperitoneum. Materials and Methods: In this retrospective study, propensity score matching was performed to minimize selection bias. The demographic data of 694 patients, along with the incidence of intraoperative hypertension and hypotension, were collected through a review of medical records. Results: A total of 694 patients met the selection criteria, all of whom underwent total intravenous anesthesia (TIVA) using either remimazolam (n = 321) or propofol (n = 373). After propensity score matching, 317 pairs were analyzed. The incidence of intraoperative hypertension was higher in the remimazolam group (66.2% vs. 52.1%; p < 0.001), whereas hypotension was more frequent in the propofol group (12.0% vs. 5.4%; p = 0.003). Conclusions: TIVA with remimazolam was associated with a higher incidence of intraoperative hypertension compared to propofol, whereas propofol was more likely to cause hypotension in patients undergoing laparoscopic gynecologic surgery.
Keywords: remimazolam; propofol; general anesthesia; Trendelenburg position; pneumoperitoneum; hemodynamics; hypotension; hypertension; remifentanil; robotic surgical procedures remimazolam; propofol; general anesthesia; Trendelenburg position; pneumoperitoneum; hemodynamics; hypotension; hypertension; remifentanil; robotic surgical procedures

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MDPI and ACS Style

Lee, J.M.; Lee, J.; Kang, S.H.; Jung, K.; Yeo, H.; Joo, Y. Comparative Effects of Remimazolam and Propofol on Intraoperative Hypertension and Hypotension During Robot-Assisted Laparoscopic Gynecologic Surgery: A Retrospective Analysis. Medicina 2025, 61, 1721. https://doi.org/10.3390/medicina61091721

AMA Style

Lee JM, Lee J, Kang SH, Jung K, Yeo H, Joo Y. Comparative Effects of Remimazolam and Propofol on Intraoperative Hypertension and Hypotension During Robot-Assisted Laparoscopic Gynecologic Surgery: A Retrospective Analysis. Medicina. 2025; 61(9):1721. https://doi.org/10.3390/medicina61091721

Chicago/Turabian Style

Lee, Jung Min, Joohyun Lee, Se Hee Kang, Kangha Jung, Hyean Yeo, and Young Joo. 2025. "Comparative Effects of Remimazolam and Propofol on Intraoperative Hypertension and Hypotension During Robot-Assisted Laparoscopic Gynecologic Surgery: A Retrospective Analysis" Medicina 61, no. 9: 1721. https://doi.org/10.3390/medicina61091721

APA Style

Lee, J. M., Lee, J., Kang, S. H., Jung, K., Yeo, H., & Joo, Y. (2025). Comparative Effects of Remimazolam and Propofol on Intraoperative Hypertension and Hypotension During Robot-Assisted Laparoscopic Gynecologic Surgery: A Retrospective Analysis. Medicina, 61(9), 1721. https://doi.org/10.3390/medicina61091721

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