When utilized for inducing anesthesia in individuals having cardiac illness, low-dose Remimazolam tosilate (0.2 mg/kg) can not only offer stable hemodynamic parameters but also result in fewer adverse responses than Etomidate, as deciphered from a prospective, randomized, double-blind, single-center trial published in "Drug Design, Development and Therapy". This study was performed to investigate the hemodynamic effects of various Remimazolam tosilate and Etomidate doses used to stimulate anesthesia during heart surgery.

Overall, 117 patients undergoing selective valve replacement surgery were randomly segregated into three groups: (1) Low-dose Remimazolam tosilate group (group LR, 0.2 mg/kg), (2) High-dose Remimazolam tosilate (group HR, 0.3 mg/kg), and (3) Etomidate (group E, 1.5 mg/kg). Fluctuations in hemodynamics during anesthesia induction (heart rate fluctuation value [∆HR] and mean arterial pressure fluctuation value [∆MAP]) were the key endpoints. The occurrence of adverse medication reactions (like injection pain and myoclonus), adverse cardiovascular events, vital signs at various time periods, and cumulative dosages of vasoactive medicines were the secondary outcomes ascertained.

Compared to group HR, group LR and group E exhibited considerably lower hemodynamic fluctuations (∆MAP), and reduced incidence of hypotension and cumulative norepinephrine doses.

In addition, compared to group E, the occurrence of injection discomfort and myoclonus in groups LR and HR was lower. Regarding ∆HR, severe bradycardia, tachycardia, hypertension, vital signs at various time periods, lactic acid, and blood glucose, there were no discernible differences between the two arms. Owing to Remimazolam tosilate's non-inferior effectiveness and higher safety profile, it appears to be a suitable alternative sedative agent for such patients.