The effects of remimazolam on stress response,inflammatory factors and postoperative short-term quality of recovery in elderly patients undergoing one-lung ventilation

Yuan Li; Gong Jie; Zhu Ying; Jiao Liping; Yan Yanan; Li Guoli; Teng Jinliang

doi:10.3760/j.issn.1673-4777.2025.08.006

Abstract：Objective To observe the effects of remimazolam on stress response,serum inflammatory factors and postoperative short-term quality of recovery in elderly patients with one-lung ventilation.Methods Sixty patients who underwent thoracoscopic radical lung cancer surgery in the First Affiliated Hospital of Hebei North University from August 2023 to August 2024 were selected.The patients were divided into group P and group R according to the random number table method,with 30 cases in each group.Group P was given propofol and remifentanil anesthesia,group R was given remimazolam and remifentanil anesthesia.The heart rate,mean arterial pressure(MAP),blood oxygen saturation,and bispectral index(BIS)were monitored and recorded before anesthesia(T1),intubation(T2),skin incision(T3),at the end of operation(T4),and extubation(T5).The occurrence of hypotension,bradycardia,hypertension and the use of vasoactive drugs during operation were recorded.The pain mediators were compared between the two groups before operation and 24 h after operation.Inflammatory mediators and stress response indexes were measured before operation,at the end of operation,and at 6 and 24 h after operation.The quality of recovery 15-item(QoR-15)scale scores were recorded before induction of anesthesia and at 24 and 72 h after operation.Results The heart rate and MAP at T4 in group R were higher than those in group P,and BIS at T5 was lower than that in group P(all P＜0.05).The incidence of hypotension,bradycardia and the use of vasoactive drugs in group R were lower than those in group P[10.0％(3/30)vs 50.0％(15/30),0(0)vs 26.6％(8/30),26.6％(8/30)vs 83.3％(25/30)](all P＜0.05).At 24 h after operation,the levels of high-mobility protein B1 protein in the two groups were lower than those before operation,and those in group R were lower than those in group P.The levels of prostaglandin E2 and 5-hydroxytryptamine in the two groups were higher than those before operation,and those in group R were higher than those in group P(all P＜0.05).The levels of C-reactive protein and interleukin-6 in the two groups were higher than those before operation immediately after operation and at 6 and 24 h after operation,but those in group R were lower than those in group P at each time point(all P＜0.05).The cortisol levels immediately after operation and 6 h after operation were higher than those before operation in both groups,but those in group R were lower than those in group P at each time point(all P＜0.05).The total QoR-15 scores at 24 h and 72 h after operation were lower than those before anesthesia induction in both groups,but those in group R were higher than those in group P(all P＜0.05).Conclusion Remimazolam can maintain hemodynamic stability and reduce the incidence of adverse cardiovascular events in elderly patients undergoing thoracoscopic radical resection of lung cancer.At the same time,it can inhibit the release of pain mediators and inflammatory factors,which is beneficial to reduce the postoperative stress response of elderly patients and improve the quality of postoperative recovery.