A Retrospective Comparative Study of the Frequency of Hypotension in Pediatric Cardiac Catheterization under General Anesthesia: Remimazolam versus Sevoflurane.

Objective: To compare the incidence of hypotension between remimazolam and sevoflurane under general anesthesia for cardiac catheterization in patients with congenital heart disease.

Design: Retrospective observational study.

Setting: A single university hospital with 300 pediatric cardiac catheterizations by general anesthesia performed annually.

Participants: Patients 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.

Interventions: General anesthesia was maintained with remimazolam or sevoflurane.

Measurements and main results: A 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).

Conclusions: Remimazolam 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.