• Tatsuhiko Shimizu, Tomoyuki Kanazawa, Tsubasa Yoshida, Takanobu Sakura, Kazuyoshi Shimizu, Tatsuo Iwasaki, and Hiroshi Morimatsu.
• Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
• J. Cardiothorac. Vasc. Anesth. 2024 Sep 5.

ObjectiveTo compare the incidence of hypotension between remimazolam and sevoflurane under general anesthesia for cardiac catheterization in patients with congenital heart disease.DesignRetrospective observational study.SettingA single university hospital with 300 pediatric cardiac catheterizations by general anesthesia performed annually.ParticipantsPatients younger than 15 years who underwent cardiac catheterization under general anesthesia between March 1, 2021, and December 31, 2022. Exclusion criteria were general anesthesia maintained with other than remimazolam or sevoflurane, receipt of remifentanil, American Society of Anesthesiologists score 4 or 5, emergency procedures, and no direct arterial pressure measurement.InterventionsGeneral anesthesia was maintained with remimazolam or sevoflurane.Measurements And Main ResultsA total of 309 patients were analyzed, including 28 in the remimazolam group and 281 in the sevoflurane group. Propensity score matching adjusted for confounding factors resulted in 28 patients in each arm, with no apparent differences in background factors. Hypotension was defined as a time-averaged area > 1, in which systolic arterial pressure fell below 80% of the baseline from the start of anesthesia to the end of procedure. The significance level was set at P < .05. The incidence of hypotension was 39.3% in the remimazolam arm and 46.4% in the sevoflurane arm, with no significant difference (P = .79), although the ratio of the median systolic arterial pressure to the baseline value was significantly higher in the remimazolam arm (91.4 ± 15.2% vs 83.2 ± 11.4% in the sevoflurane arm; P = .03).ConclusionsRemimazolam was not associated with a lower incidence of hypotension compared to sevoflurane during pediatric cardiac catheterization for congenital heart disease while maintaining significantly higher blood pressure overall.Copyright © 2024 Elsevier Inc. All rights reserved.

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