Background: Remimazolam is a novel ultra-short-acting benzodiazepine known for its hemodynamic stability over propofol. However, its hemodynamic effects compared to those of etomidate are not well established. This study aimed to determine whether the use of remimazolam is non-inferior to etomidate with regard to the occurrence of post-induction hypotension in patients undergoing coronary artery bypass grafting. Methods: Patients were randomly assigned to either the remimazolam group (6 mg/kg/h) or the etomidate group (0.3 mg/kg) for induction of anesthesia. Anesthetic depth was adjusted based on the bispectral index. Primary outcome was the incidence of post-induction hypotension, defined as a mean arterial pressure less than 65 mmHg within 15 min after endotracheal intubation, with a non-inferiority margin of 12%. Results: A total of 144 patients were finally analyzed. Incidence of post-induction hypotension was 36/71 (50.7%) in the remimazolam group and 25/73 (34.2%) in the etomidate group, with a rate difference of 16.5% (95% CI [3.0–32.6]) between the two groups that was beyond the prespecified non-inferiority margin of 12.0%. The number of patients who needed vasopressors was similar in the two groups. Conclusions In this non-inferiority trial, remimazolam failed to show non-inferiority to etomidate in terms of post-induction hypotension when used as an induction drug for general anesthesia in patients undergoing coronary artery bypass grafting. However, different doses or infusion techniques of remimazolam should be compared with etomidate in various patient groups to fully assess its hemodynamic non-inferiority during induction of anesthesia.

Background: Remimazolam is a novel ultra-short-acting benzodiazepine known for its hemodynamic stability over propofol. However, its hemodynamic effects compared to those of etomidate are not well established. This study aimed to determine whether the use of remimazolam is non-inferior to etomidate with regard to the occurrence of post-induction hypotension in patients undergoing coronary artery bypass grafting. Methods: Patients were randomly assigned to either the remimazolam group (6 mg/kg/h) or the etomidate group (0.3 mg/kg) for induction of anesthesia. Anesthetic depth was adjusted based on the bispectral index. Primary outcome was the incidence of post-induction hypotension, defined as a mean arterial pressure less than 65 mmHg within 15 min after endotracheal intubation, with a non-inferiority margin of 12%. Results: A total of 144 patients were finally analyzed. Incidence of post-induction hypotension was 36/71 (50.7%) in the remimazolam group and 25/73 (34.2%) in the etomidate group, with a rate difference of 16.5% (95% CI [3.0–32.6]) between the two groups that was beyond the prespecified non-inferiority margin of 12.0%. The number of patients who needed vasopressors was similar in the two groups. Conclusions In this non-inferiority trial, remimazolam failed to show non-inferiority to etomidate in terms of post-induction hypotension when used as an induction drug for general anesthesia in patients undergoing coronary artery bypass grafting. However, different doses or infusion techniques of remimazolam should be compared with etomidate in various patient groups to fully assess its hemodynamic non-inferiority during induction of anesthesia.

Background: Remimazolam is a novel ultra-short-acting benzodiazepine known for its hemodynamic stability over propofol. However, its hemodynamic effects compared to those of etomidate are not well established. This study aimed to determine whether the use of remimazolam is non-inferior to etomidate with regard to the occurrence of post-induction hypotension in patients undergoing coronary artery bypass grafting. Methods: Patients were randomly assigned to either the remimazolam group (6 mg/kg/h) or the etomidate group (0.3 mg/kg) for induction of anesthesia. Anesthetic depth was adjusted based on the bispectral index. Primary outcome was the incidence of post-induction hypotension, defined as a mean arterial pressure less than 65 mmHg within 15 min after endotracheal intubation, with a non-inferiority margin of 12%. Results: A total of 144 patients were finally analyzed. Incidence of post-induction hypotension was 36/71 (50.7%) in the remimazolam group and 25/73 (34.2%) in the etomidate group, with a rate difference of 16.5% (95% CI [3.0–32.6]) between the two groups that was beyond the prespecified non-inferiority margin of 12.0%. The number of patients who needed vasopressors was similar in the two groups. Conclusions In this non-inferiority trial, remimazolam failed to show non-inferiority to etomidate in terms of post-induction hypotension when used as an induction drug for general anesthesia in patients undergoing coronary artery bypass grafting. However, different doses or infusion techniques of remimazolam should be compared with etomidate in various patient groups to fully assess its hemodynamic non-inferiority during induction of anesthesia.

Background: Remimazolam is a novel ultra-short-acting benzodiazepine known for its hemodynamic stability over propofol. However, its hemodynamic effects compared to those of etomidate are not well established. This study aimed to determine whether the use of remimazolam is non-inferior to etomidate with regard to the occurrence of post-induction hypotension in patients undergoing coronary artery bypass grafting. Methods: Patients were randomly assigned to either the remimazolam group (6 mg/kg/h) or the etomidate group (0.3 mg/kg) for induction of anesthesia. Anesthetic depth was adjusted based on the bispectral index. Primary outcome was the incidence of post-induction hypotension, defined as a mean arterial pressure less than 65 mmHg within 15 min after endotracheal intubation, with a non-inferiority margin of 12%. Results: A total of 144 patients were finally analyzed. Incidence of post-induction hypotension was 36/71 (50.7%) in the remimazolam group and 25/73 (34.2%) in the etomidate group, with a rate difference of 16.5% (95% CI [3.0–32.6]) between the two groups that was beyond the prespecified non-inferiority margin of 12.0%. The number of patients who needed vasopressors was similar in the two groups. Conclusions In this non-inferiority trial, remimazolam failed to show non-inferiority to etomidate in terms of post-induction hypotension when used as an induction drug for general anesthesia in patients undergoing coronary artery bypass grafting. However, different doses or infusion techniques of remimazolam should be compared with etomidate in various patient groups to fully assess its hemodynamic non-inferiority during induction of anesthesia.

Purpose: Ankle fractures are common in the orthopedic field. Lateral malleolar fractures are often treated with lag screws and locking plates. Cortical screws are typically used as lag screws to achieve absolute stability through compression. In osteoporotic bone, however, achieving sufficient compression with cortical screws can be challenging. Cancellous screws may offer better fixation in metaphyseal bone. This study compared the outcomes of using cortical screws as lag screws and cancellous screws as position screws for lateral malleolar fixation. Materials and Methods: This retrospective study included patients who underwent surgery for Weber type B ankle fractures at the authors’ hospital between March 2019 and March 2022. The patients were divided into two groups based on the screw type: cortical lag screws (n=70) and cancellous position screws (n=35). In both groups, a locking plate was applied in the same manner after screw fixation. The outcomes were evaluated using the visual analog scale (VAS), Olerud-Molander score (OMS), foot and ankle outcome score (FAOS), and foot function index (FFI). Complications, such as fixation failure, nonunion, and malunion, were recorded. Results: One hundred and five patients were included. The mean follow-up duration was 16 months (range, 12~28 months). The VAS (1.6±1.9 vs. 1.1±1.3, p=0.305), FFI (10.3±13.4 vs. 10.4±13.5, p=0.970), FAOS (83.0±14.4 vs. 83.5±14.4, p=0.899), and OMS (85.3±18.4 vs.84.7±17.6, p=0.910) scores were similar in the two groups. No complications were reported in either group. Conclusion For the fixation of Weber B fibular fractures, cortical lag screws and cancellous position screws showed comparable clinical outcomes. Cancellous screws with plate fixation may offer a viable alternative in cases with poor bone quality or difficulty applying lag screw techniques.

Purpose: Ankle fractures are common in the orthopedic field. Lateral malleolar fractures are often treated with lag screws and locking plates. Cortical screws are typically used as lag screws to achieve absolute stability through compression. In osteoporotic bone, however, achieving sufficient compression with cortical screws can be challenging. Cancellous screws may offer better fixation in metaphyseal bone. This study compared the outcomes of using cortical screws as lag screws and cancellous screws as position screws for lateral malleolar fixation. Materials and Methods: This retrospective study included patients who underwent surgery for Weber type B ankle fractures at the authors’ hospital between March 2019 and March 2022. The patients were divided into two groups based on the screw type: cortical lag screws (n=70) and cancellous position screws (n=35). In both groups, a locking plate was applied in the same manner after screw fixation. The outcomes were evaluated using the visual analog scale (VAS), Olerud-Molander score (OMS), foot and ankle outcome score (FAOS), and foot function index (FFI). Complications, such as fixation failure, nonunion, and malunion, were recorded. Results: One hundred and five patients were included. The mean follow-up duration was 16 months (range, 12~28 months). The VAS (1.6±1.9 vs. 1.1±1.3, p=0.305), FFI (10.3±13.4 vs. 10.4±13.5, p=0.970), FAOS (83.0±14.4 vs. 83.5±14.4, p=0.899), and OMS (85.3±18.4 vs.84.7±17.6, p=0.910) scores were similar in the two groups. No complications were reported in either group. Conclusion For the fixation of Weber B fibular fractures, cortical lag screws and cancellous position screws showed comparable clinical outcomes. Cancellous screws with plate fixation may offer a viable alternative in cases with poor bone quality or difficulty applying lag screw techniques.