Effect of Remimazolam Versus Propofol Total Intravenous Anesthesia on Intraoperative Hemodynamic Stability in Patients Undergoing Thoracic or Abdominal Endovascular Aortic Repair

Effect of Remimazolam Versus Propofol Total Intravenous Anesthesia on Intraoperative Hemodynamic Stability in Patients Undergoing Thoracic or Abdominal Endovascular Aortic Repair: A Randomized, Single-blind, Controlled Clinical Trial

The purpose of this study is to compare two intravenous anesthetics, remimazolam and propofol, for their effects on intraoperative hemodynamic stability in patients undergoing thoracic or abdominal endovascular aortic repair. Maintaining blood pressure during these procedures is important to preserve organ perfusion, yet anesthetic-induced hypotension often requires vasopressor support. Since direct comparisons of these two anesthetics on hemodynamic outcomes in this population are limited, this randomized, single-blind, controlled trial will compare the intraoperative vasopressor requirement between the two groups to provide evidence for selecting a more hemodynamically stable anesthetic in these high-risk patients.

Inclusion Criteria:

- Adults aged 20 years or older scheduled for thoracic or abdominal endovascular aortic repair (TEVAR/EVAR) under general anesthesia for thoracic or abdominal aortic aneurysm

Exclusion Criteria:

• Known or suspected allergy or hypersensitivity to the study drugs
• ASA physical status class IV or higher
• Body mass index (BMI) ≥ 30 kg/m^2
• Chronic use of opioids or benzodiazepines
• History of alcohol or drug abuse
• Preoperative cognitive impairment
• Severe left ventricular dysfunction (left ventricular ejection fraction < 40%)
• Severe hepatic dysfunction (Child-Pugh class C)
• Severe hypoalbuminemia (< 2.0 g/dL)
• Acute or chronic renal failure requiring dialysis
• Pregnancy or breastfeeding
• Emergency procedure