REmimazolam vs Propofol Total Intravenous Anesthesia on Outcomes After Major Noncardiac SurgEry

Inclusion criteria

• Age ≥45 years;
• Undergoing elective major surgery under general anesthesia (expected surgery time >2 h, expected length of postoperative stay >2 d);
• Fulfilling ≥1 of the following criteria:

• history of coronary artery disease;
• history of stroke;
• history of congestive heart failure;
• preoperative NT-proBNP >200 pg/mL or BNP>92 pg/mL;
• age ≥70 years;
• diabetes requiring medical treatment;
• ASA status 3 or 4;
• history of chronic kidney disease (preoperative sCr >133 μmol/L or 1.5 mg/dL);
• history of peripheral arterial disease;
• preoperative serum albumin <30 g/L;
• preoperative hemoglobin <100 g/L.

Exclusion criteria

• Undergoing organ transplantation, cardiac, craniocerebral, burn or interventional operations;
• Low risk or minor surgery
• End-stage renal disease requiring renal-replacement therapy;
• Hepatic dysfunction (Child B or C);
• Previous liver or kidney transplantation;
• Previous allergy to general anesthetics;
• Unable to receive bispectral index monitoring;
• ASA score ≥5;
• Exposure to general anesthesia in prior 30 days or anticipated re-exposure to general anesthesia within 30 days after surgery;
• Need for prolonged airway protection or mechanical ventilatory support after surgery;
• Current participation in another interventional study;
• Previous participation in this study;
• Pregnant or breastfeeding women.