CLINICAL TRIAL article
Front. Cardiovasc. Med.
Sec. Cardiovascular Surgery
Effects of Remimazolam Preconditioning on Inflammatory Reaction and Hemodynamics in Patients Undergoing Cardiopulmonary Bypass
1. Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
2. The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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Abstract
Objective: Cardiopulmonary bypass (CPB) during cardiac surgery often induces systemic inflammation, potentially leading to multi-organ dysfunction. This study investigated whether remimazolam preconditioning could reduce inflammatory responses and postoperative complications in CPB patients. The primary endpoint was the postoperative difference in white blood cell (WBC) counts between groups. Methods: Eighty-six patients undergoing CPB were randomly assigned to receive remimazolam or saline. Hemodynamic parameters (heart rate [HR] and mean arterial pressure [MAP]) and inflammatory markers—WBC count, interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and procalcitonin (PCT)—were measured at multiple time points. Postoperative outcomes included duration of mechanical ventilation, ICU stay, and incidences of infection, acute kidney injury, acute liver injury, multiple organ dysfunction syndrome (MODS), and 30-day mortality. Results: Remimazolam had no significant effect on intraoperative HR (P = 0.354) or MAP (P = 0.162) but significantly reduced postoperative inflammatory markers. Exploratory analyses suggested improved clinical outcomes in the remimazolam group, including shorter mechanical ventilation (2.06 ± 1.67 vs. 3.15 ± 0.49 days, P = 0.049) and ICU stay (2.87 ± 2.49 vs. 6.12 ± 1.48 days, P = 0.002), as well as lower rates of infection (20.93% vs. 56.09%), kidney injury (4.76% vs. 21.95%), and MODS (4.76% vs. 19.51%). Conclusion: Remimazolam preconditioning attenuates systemic inflammation and reduces postoperative complications in CPB patients without affecting hemodynamic stability, suggesting its potential as an adjunctive therapy in cardiac surgery.
Summary
Keywords
Cardiopulmonary Bypass, Postoperative Complications, Remimazolam, systemic inflammation, White blood cell count
Received
05 October 2025
Accepted
26 January 2026
Copyright
© 2026 Zhenyi, Chen, Dianqing, Tang, Zhang and Mo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Guixi Mo
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