[Remimazolam stabilizes hemodynamics during anesthesia induction but fails to reduce renal injury risk following laparoscopic partial nephrectomy: a propensity score-matched retrospective cohort study].
To investigate the effects of remimazolam administered during anesthesia induction on hemodynamics and postoperative renal function in patients undergoing laparoscopic partial nephrectomy (LPN).
Clinical data of 265 renal tumor patients undergoing LPN between January, 2022 and December, 2024 were collected. The patients were divided into control group and remimazolam group (0.2 mg/kg for induction), and after propensity score matching (PSM), 65 patients in each group were included. Mean arterial pressure (MAP) and heart rate (HR) were recorded before induction (T0), immediately after induction (T1), immediately after intubation (T2), and 10 min after intubation (T3). Renal function indicators at 24 h postoperatively and incidences of acute kidney injury (AKI) were recorded. Estimated glomerular filtration rates (eGFRsCr, eGFRCys-C, and eGFRdiff) were calculated using serum creatinine (sCr) and cystatin C (Cys-C). From 36 patients in control group and 41 patients in remimazolam group followed up for 3-12 months, eGFRsCr data were collected to evaluate the incidence of chronic kidney disease (CKD) and analyze its correlation with AKI.
After PSM and covariate adjustment, remimazolam group showed significantly smaller changes than control group in ΔMAP at T3 (-20.11±11.65 vs -13.54±12.75 mmHg, P<0.05), ΔHR at T2 (-3.78±11.18 vs 2.82±10.79 min-1, P<0.05), and ΔHR at T3 (-10.85±15.54 vs -3.35±11.67 min-1, P<0.05). The remimazolam group showed significantly higher postoperative Cys-C level than the control group [0.96 (0.96, 1.03) vs 0.91 (0.77, 1.01), P<0.05] but lower eGFRCys-C at 24 h (83.65±9.84 vs 94.83±20.92, P<0.05). eGFRdiff showed a significant negative shift in remimazolam group (18.55±17.06 vs 8.52±15.85, P<0.05). Other indicators did not differ significantly between the two groups. AKI showed a significant correlation with CKD following LPN (P<0.05).
Compared with propofol, remimazolam induction improves hemodynamic stability during anesthesia induction but does not reduce the incidences of postoperative AKI or CKD after LPN.
Clinical data of 265 renal tumor patients undergoing LPN between January, 2022 and December, 2024 were collected. The patients were divided into control group and remimazolam group (0.2 mg/kg for induction), and after propensity score matching (PSM), 65 patients in each group were included. Mean arterial pressure (MAP) and heart rate (HR) were recorded before induction (T0), immediately after induction (T1), immediately after intubation (T2), and 10 min after intubation (T3). Renal function indicators at 24 h postoperatively and incidences of acute kidney injury (AKI) were recorded. Estimated glomerular filtration rates (eGFRsCr, eGFRCys-C, and eGFRdiff) were calculated using serum creatinine (sCr) and cystatin C (Cys-C). From 36 patients in control group and 41 patients in remimazolam group followed up for 3-12 months, eGFRsCr data were collected to evaluate the incidence of chronic kidney disease (CKD) and analyze its correlation with AKI.
After PSM and covariate adjustment, remimazolam group showed significantly smaller changes than control group in ΔMAP at T3 (-20.11±11.65 vs -13.54±12.75 mmHg, P<0.05), ΔHR at T2 (-3.78±11.18 vs 2.82±10.79 min-1, P<0.05), and ΔHR at T3 (-10.85±15.54 vs -3.35±11.67 min-1, P<0.05). The remimazolam group showed significantly higher postoperative Cys-C level than the control group [0.96 (0.96, 1.03) vs 0.91 (0.77, 1.01), P<0.05] but lower eGFRCys-C at 24 h (83.65±9.84 vs 94.83±20.92, P<0.05). eGFRdiff showed a significant negative shift in remimazolam group (18.55±17.06 vs 8.52±15.85, P<0.05). Other indicators did not differ significantly between the two groups. AKI showed a significant correlation with CKD following LPN (P<0.05).
Compared with propofol, remimazolam induction improves hemodynamic stability during anesthesia induction but does not reduce the incidences of postoperative AKI or CKD after LPN.