COMPARISON BETWEEN THE USE OF REMIMAZOLAM AND PROPOFOLEM GENERATING ARTERIAL HYPOTENSION DURING ANESTHETIC INDUCTION: AN INTEGRATIVE REVIEW (Atena Editora)

Abstract

Worldwide, more than 300 million major surgeries are performed per year, with the majority of these using general anesthesia. Among the most used anesthetics is propofol, a drug that inhibits the neurotransmitter gamma-aminobutyric acid (GABA). However, despite being widely used, the administration of propofol induces intraoperative hypotension, mainly due to the reduction in vascular resistance. Another anesthetic, Remimazolam, is a new emerging medication with a similar effect to propofol, being an ultra-short-acting benzodiazepine. Compared to propofol, remimazolam has fewer hemodynamic side effects, and may play an important role in preventing intraoperative hypotension. Considering the great impact on the health of those affected by intraoperative hypotension and postoperative damage, this work aims to analyze in recent literature the best evidence regarding the hypotensive effect of two drugs used in anesthetic induction, remimazolam and propofol, in order to compare them and verify which one presents the best benefit, among the different surgeries and patient profiles, with the aim of avoiding hypotensive effects. This is a qualitative, retrospective and cross-sectional study carried out through an integrative literature review. The databases used were the National Library of Medicine (PubMed) and Virtual Health Library (VHL). Among the studies analyzed, several procedures from different surgical categories were compared, such as: EDA, bronchoscopy, conization, colonoscopy, hysteroscopy, orthopedic surgery, valve replacement and endoscopic retrograde cholangiopancreatography. In all cases, it was possible to perceive the same outcome: a greater degree of arterial hypotension related to the use of Propofol during anesthetic induction when compared to Remimazolam. Therefore, it can be concluded that, from a hemodynamic point of view, there is a clear advantage of using the combination of Remifentanil with Midazolam in relation to the exclusive use of Propofol for anesthetic induction, with smaller variations in MAP, HR and, consequently, Cardiac Output. in the groups in which Remidazolam was used.