Please confirm that an ethics committee approval has been applied for or granted: Not relevant

Background and Aims The prevalence of intraoperative hypotension has garnered significant attention due to its impact on organ perfusion and potential adverse effects. Both spinal anesthesia and sedation contribute to hypotension occurrence, heightening the risk for patients who receive sedative drugs during spinal anesthesia. This study was designed to explore the differences in hypotension frequency between propofol and remimazolam sedation, a traditional and emerging sedative choice respectively, known for their rapid onset and offset of action, during hip surgeries in spinal anesthesia.

Methods A total of 78 patients of age group 20-65 years of American Society of Anesthesiologists grade I-III, posted for hip surgeries under spinal anesthesia were randomly divided into two groups (n=39 each) to receive remimazolam (Group R) or propofol (Group P) infusion targeting a Modified Observer’s Assessment of Alertness/Sedation(MOAA/S) score of 3. The primary outcome was the frequency of hypotensive episodes, defined by mean blood pressure < 65mmHg, in the first hour of infusion. Secondary outcomes included the incidence of hypotension during surgery, other hemodynamic variables, the incidence of rescue phenylephrine use, and postoperative adverse outcomes.

Results The incidence of hypotension during surgery was significantly lower with remimazolam than propofol(23 vs 33; P=0.02). However, there were no significant differences in the frequency of hypotensive episodes, other hemodynamic variables, use of hemodynamic rescue drugs, or postoperative adverse outcomes.

Conclusions Remimazolam, with its minimal effects on hemodynamic, could be a valuable adjunct for intraoperative sedation during hip surgery under spinal anesthesia.