Comparison of Remimazolam and Propofol in Large Skull Base Tumor Resections: Effects on Hemodynamic Stability, Neurocognitive Recovery, and Inflammatory Response.

PURPOSE: Skull base large tumor resections require precise hemodynamic control and neuroprotection. This study compared remimazolam and propofol effects on perioperative stability, postoperative neurocognitive recovery, and inflammatory responses in these patients. METHODS: This retrospective study included patients who underwent large skull base tumor resections between March 2020 and February 2022. Patients were assigned to remimazolam or propofol group based on the primary anesthetic used. Hemodynamic parameters such as blood pressure, heart rate (HR), and mean arterial pressure (MAP) were recorded during the perioperative period. Serum levels of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) were measured preoperatively and on postoperative days 1, 3, and 7. Neurocognitive function was assessed using the Montreal Cognitive Assessment (MoCA). RESULTS: The analysis included 257 patients (remimazolam group: n=122; propofol group: n=135). The remimazolam group showed higher systolic blood pressure at most measurement points after induction (immediately before tracheal intubation: 108.24 vs. 105.75, P=0.006), diastolic blood pressure (5 min after extubation: 78.29 vs. 74.87, P=0.005), MAP (immediately before tracheal intubation: 74.83 vs. 70.57, P=0.002), and HR (5 min after extubation: 77.14 vs. 72.93, P=0.002). Postoperative MoCA scores were higher in the remimazolam group (24 hours: 24.18 vs. 23.45, P=0.005). The remimazolam group also had lower levels of postoperative TNF-α (40.21 vs. 41.55, P=0.011) and IL-6 (63.15 vs. 65.19, P=0.013). The incidence of hypotension was lower in the remimazolam group (13.93% vs. 27.41%, P=0.008). CONCLUSION: For patients with large skull base tumor resections, remimazolam offers better hemodynamic stability, improved early neurocognitive recovery, and milder inflammatory responses compared to propofol.