Ying Cao,1,* Mi Gan,1,2,* Linling Wan,3,* Jun Lu,1,2 Ting Liu,1,2 Meiyan Liu,1,2 Di Wang,1 Sen Hong,1 Lin Zhou,1 Luying Deng,1 Zijun Wang,1 Jingjie Wang,1 Changyu Sun,1 Yang Liu,4 Yanqiu Liu,2,5 Meiwu Zhou1 

1Department of Anesthesiology, The Second People’s Hospital of Guiyang, The Affiliated Jinyang Hospital of Guizhou Medical University, Guiyang, People’s Republic of China; 2School of Anesthesiology, Guizhou Medical University, Guiyang, People’s Republic of China; 3Chongqing Population and Family Planning Science and Technology Research Institute, Chongqing, People’s Republic of China; 4Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, People’s Republic of China; 5Department of Anesthesiology, The Fourth People’s Hospital of Guiyang, Guiyang, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Yanqiu Liu, Department of Anesthesiology, The Fourth People’s Hospital of Guiyang, No. 91, Jiefang West Road, Nanming District, Guiyang, Guizhou, 550002, People’s Republic of China, Tel +86 13595161013, Email 1150725102@qq.com Meiwu Zhou, Department of Anesthesiology, The Second People’s Hospital of Guiyang, The Affiliated Jinyang Hospital of Guizhou Medical University, No. 547, Jinyang South Road, Guanshanhu District, GuiYang, Guizhou, 550081, People’s Republic of China, Tel +86 15286065939, Email 80511920@qq.com

Background: Remimazolam tosilate, a novel ultra-short-acting benzodiazepine, demonstrates promising safety profiles in clinical settings. While both remimazolam tosilate and etomidate provide hemodynamic stability during anesthesia induction, limited research has directly compared their effects on electroencephalogram (EEG) burst suppression (periods of transient brain wave silence), a potential predictor of adverse neurological outcomes. This study aims to compare the incidence rate of EEG burst suppression (ESR) with remimazolam tosilate versus etomidate by reviewing the drug regimens used by different anesthesiologists in clinical practice.
Methods: This single-center retrospective study analyzed clinical anesthesia induction data from 161 patients from October 2023 to July 2024. Patients received either remimazolam tosilate (0.2 mg/kg, n=86, Group R) or etomidate (0.3 mg/kg, n=75, Group E) for general anesthesia induction. Primary outcomes included ESR and its duration during induction. Second outcomes comprised hemodynamic parameters: systolic blood pressure, diastolic blood pressure mean arterial pressure, and heart rate, measured at baseline (T0), 3 minutes post-induction (T1), immediately after intubation (T2), 5 minutes post-intubation (T3), 10 minutes post-intubation (T4), and adverse events occurrence.
Results: Baseline characteristics were comparable except ASA classification (higher ASA III proportion in Group R: 24.4% vs 2.7%, P< 0.001). No ESR occurred in Group R versus 29.34% in Group E (P< 0.01). Group R had a significantly lower incidence of intubation-related hypertension (10.5% vs 42.7%, P< 0.001) and maintained stable blood pressure and HR throughout induction, whereas Group E exhibited marked MAP and HR fluctuations. Other adverse events showed no significant inter-group differences.
Conclusion: Remimazolam tosilate demonstrated notable differences compared to etomidate during general anesthesia induction, including the absence of ESR and different hemodynamic response patterns. While these findings suggest potential advantages for certain patient populations, the retrospective design and ASA classification imbalance limit definitive conclusions, warranting prospective validation studies.

Keywords: EEG burst suppression, remimazolam tosilate, etomidate, hemodynamic stability, general anesthesia induction