Discussion
PIH, postoperative delirium, breast cancer, nausea and vomiting, hypertensive, hypotension, hypertension, trauma
BREAST CANCER, ADVERSE EVENTS, ADVERSE EVENT, SECONDARY, HYPERTENSION, COMPLICATIONS
In this study, we compared general anesthesia with remimazolam and propofol in terms of PIH in patients undergoing breast cancer surgery. Our results revealed that the remimazolam group had a lower incidence of PIH than that of the propofol group. We used several definitions of hypotension, and although the incidence of hypotension varied between the two groups, the results remained consistent (Supplemental Table There was no significant difference in hemodynamics between the two groups after the start of surgery, which could be attributed to the adjustment of sevoflurane dosage based on BIS and blood pressure. We believe that remimazolam is safe, efficacious, and non-inferior to propofol for maintaining anesthesia in patients with hypertension.Our study found no significant difference in the QoR-40 scores between the two groups 1 day after surgery. However, Mao et al. [Adverse events recorded in the PACU, including nausea and vomiting, blood pressure fluctuations, intraoperative awareness, and postoperative delirium, were similar between the two groups. It should be noted that these adverse events were secondary outcomes, and the sample size was insufficient. Meanwhile, if the sedation level of remimazolam is more accurately controlled by administering the antagonist flumazenil, the rate of adverse events might change. Therefore, further investigation of the adverse events associated with remimazolam is warranted.There were some limitations to this study. First, the hypertensive patients chosen were only those undergoing breast cancer surgery. As the surgical trauma of breast cancer surgery is minimal and the patients recover quickly, the influence of anesthetics on patients during and after surgery can be easily concealed. Second, there was no stratification of hypertension in this study, as the sensitivity to anesthetic drugs, incidence of hypotension, and prognosis of patients with different degrees of hypertension may be different. Finally, the follow-up of patients was limited to 1 day, and there was a lack of observation and documentation of long-term complications.