Effects of Remazolam versus Propofol combined with low-dose Esketamine anesthesia on hemodynamics and stress response in patients undergoing hysteroscopic surgery

XU Shuxin; BAO Yiyong

doi:10.3969/j.issn.1002-3429.2026.02.013

Abstract：Objective To compare the effects of Propofol versus Remazolam combined with low-dose Esketamine anesthesia on hemodynamics and stress response in patients undergoing hysteroscopic surgery.Methods A total of 140 patients undergoing hysteroscopic surgery from October 2022 to October 2023 were prospectively selected and divided into group P(n=70)and group R(n=70)using a sealed-envelope method.Group P was treated with Esketamine combined with Propofol during the induction period,and group R was treated with Esketamine combined with Remazolam during the induction period.The duration of anesthesia induction and time to postoperative emergence,hemodynamic parameters[systolic blood pressure(SBP),diastolic blood pressure(DBP),pulse oxygen saturation(SpO2),heart rate]upon entering the room(T0),at 2 min after anesthetic administration(T1),after examination(T2),after vaginal dilator withdrawal(T3),and at emergence(T4),stress response indicators[adrenaline,cortisol]before operation and at 30 m after operation,degree of sedation and agitation during the recovery period[Ramsay sedation scale(RSS)score,postoperative emergence agitation/delirium(PEAD)score],and occurrence of adverse reactions during the recovery period were compared between the two groups.Results There was no significant difference in duration of anesthesia induction and time to postoperative emergence between the two groups(P＞0.05),nor significant difference in SBP,DBP,SPO2 and heart rate between the two groups at T0,T1,T2,T3 and T4(P＞0.05).At 30 min after operation,epinephrine and cortisol in group R were lower than those in group P(P＜0.05),and there was no significant difference in RSS score between group R and group P during the recovery period(P＞0.05).The PAES score of group R was lower than that of group P(P＜0.01),and there was no significant difference in the incidence of SpO2 reduction,nausea and vomiting,and drowsiness between the two groups(P＞0.05).The incidence of agitation in group R was lower than that in group P(P＜0.05).Conclusion The anesthetic effects of Remazolam combined with low-dose Esketamine and Propofol combined with low-dose Esketamine are comparable,both stabilizing intraoperative hemodynamics.However,the former is more effective in alleviating perioperative stress response and decreasing the incidence of emergence agitation.