Effects of Remimazolam on Postoperative Myocardial Injury

This study is designed as a prospective, double-blind, randomized controlled trial to compare the differential effects between remimazolam and propofol on intraoperative cardiac output (CO) in elderly patients undergoing general anesthesia. Postoperative serial measurements of high-sensitivity cardiac troponin T (hs-cTnT) will be performed, and all enrolled participants will be prospectively followed up for 30 days postoperatively to document the incidence of Myocardial Injury after Noncardiac Surgery (MINS). The core technical workflows of this trial are standardized titration of study drug dosage, continuous intraoperative hemodynamic monitoring of CO, and systematic, time-point-aligned collection of perioperative biomarkers including hs-cTnT.

Inclusion criteria

• Age ≥ 65 years
• Elderly hospitalized patients scheduled to undergo general anesthesia
• American Society of Anesthesiologists (ASA) physical status I-III
• Surgery to be performed in the supine position
• Ability to communicate with the investigator and to cooperate in completing the assessment scales
• Expected duration of surgery ≥ 2 hours

Exclusion criteria

• Congenital heart disease, severe cardiac conduction block, or implanted cardiac pacemaker;
• History of cerebral infarction, cerebral hemorrhage, or stroke within the past 3 months;
• Known allergy to remimazolam or propofol;
• Severe mental illness, history of analgesic abuse, or addiction to psychotropic drugs;
• Patient or family members refuse surgery or anesthesia, or are unable to complete the required questionnaires.