Remimazolam is more suitable for general anesthesia bronchoscopy in tuberculosis patients treated with isoniazid: a retrospective cohort analysis.

OBJECTIVE: The objective of this study was to assess the suitability of remimazolam compared to propofol for general anesthesia during tracheoscopic procedures in patients with tuberculosis undergoing treatment with isoniazid. PATIENTS AND METHODS: A retrospective analysis was conducted on 1,098 patients diagnosed with pulmonary tuberculosis who underwent bronchoscopic general anesthesia at our institution between January and June 2023 (Protocol No. 2022LY0416). The patients were categorized into remimazolam and propofol groups based on the primary anesthetic agent administered. The primary outcomes assessed included the time from the conclusion of anesthesia to patient awakening, as well as hemodynamic changes during the anesthesia period. RESULTS: The time from drug withdrawal to awakening was significantly shorter in the remimazolam group compared to the propofol group (38.0 s vs. 100.0 s, P < 0.001). Additionally, the time to extubation was reduced in the remimazolam group (88.5 s vs. 181.0 s, P < 0.001), although the time to induction of anesthesia was longer, and the post-anesthesia Aldrete score was higher in the remimazolam group than in the propofol group (P < 0.001). These findings were consistently observed in subgroup analyses. During anesthesia maintenance, the amount of intraoperative vasoactive drugs (dopamine and nicardipine) administered to patients in the remimazolam group was lower than that in the propofol group (P = 0.014 and P = 0.031, respectively). Furthermore, during anesthesia, blood pressure in the remimazolam group was higher and more stable, exhibiting smaller fluctuations compared to the propofol group. Specifically, changes in systolic blood pressure were 38.2 ± 15.9 mmHg in the remimazolam group compared to 46.7 ± 19.0 mmHg in the propofol group (P < 0.001), while changes in diastolic blood pressure were 6.4 ± 16.4 mmHg in the remimazolam group versus 12.7 ± 18.7 mmHg in the propofol group (P = 0.002). CONCLUSION: In patients with tuberculosis undergoing treatment with isoniazid, general anesthesia with remimazolam was associated with a shorter time from the cessation of anesthesia to recovery, a reduced requirement for vasoactive agents, and improved hemodynamic stability, without an increase in postoperative complications, when compared to propofol.