Remimazolam tosylate vs. propofol: effects on anesthetic efficacy and renal function in living donor kidney transplantation.
Wu, J., et al.BMC Anesthesiol. 2025 Dec 22;25(1):617.
Aims
This study investigated the effect of Remimazolam Tosylate (RT) in living donor renal transplant recipients.
Interventions
Participants were randomised to either the RT group or the propofol group.
Participants
86 living donor kidney transplant recipients with uremia.
Outcomes
Primary endpoints: perioperative anesthetic efficacy and renal graft function postoperation. Secondary endpoints: perioperative electrolyte status, and incidence of hypotension and other adverse reactions.
Follow-up
1 month
CET Conclusions
Remimazolam tosylate (RT) is a novel ultra-short acting benzodiazepine which is used as an alternative to propofol induction and has shown superior haemodynamic outcomes in the general surgery patient population. Its metabolism is independent of renal function and the authors hypothesized that this would translate to more effective anaesthetic in patients undergoing KT. This randomised controlled trial compared the efficacy of RT to propofol induction in patients undergoing live donor kidney transplantation. The primary outcomes included anaesthetic efficacy (as measured by, inter alia, time to loss of consciousness, induction success rate, time to extubation) and post operative renal function. Secondary outcomes included intraoperative haemodynamic parameters and injection pain. 91 patients were randomised equally to either RT or propofol induction. Pre-operative factors were similar between the two groups, as were the other elements of the anaesthetic (i.e. analgesia and muscle relaxation). The RT group had a slightly longer induction time (83 vs 75 seconds) and lower rate of induction hypotension (16% vs 33%). Injection pain was less frequent in the RT group. Of note, 10 patients in the RT group required reversal with flumazenil as their waking time exceeded 30 min. The results of this trial are broadly similar to reports in other surgical patient populations – RT use as induction therapy shows improved haemodynamics during the induction period but at the cost of longer induction and waking times.
Data analysis
Per protocol analysis
Trial registration
ChiCTR2400083451