Abstract:Objective To compare the anesthetic efficacy and effects on postoperative recovery of remimazolam, ciprofol and propofol, when applied separately for total intravenous anesthesia in laparoscopic cholecystectomy. Methods A total of 135 patients scheduled for elective laparoscopic cholecystectomy in Baoding No.1 Central Hospital between April 2023 and November 2024 were enrolled. The patients were divided into remimazolam group (Group R), ciprofol group (Group C) and propofol group (Group P) using the random number table method, 45 cases in each group. For anesthesia induction: Group R received intravenous injection of remimazolam 0.3 mg/kg; Group C received 0.15 mg/kg, followed by intravenous injection of remifentanil 2 μg/kg 3 minutes later for tracheal intubation. For anesthesia maintenance: all three groups were administered continuous intravenous infusion of remifentanil 0.2 μg/ (kg· min) ; Group R received remimazolam 1 mg/ (kg · h), Group C received ciprofol 0.8 mg/ (kg · h), and Group P received with propofol 4 mg/ (kg · h) via continuous infusion. The observation indicators included mean arterial pressure (MAP), heart rate, saturation of peripheral oxygen (SpO2) and bispectral index (BIS) at the following time points: before anesthesia induction (T0), 3 minutes after administration of anesthetic sedatives (T1), immediately after intubation (T2), 1 minute after extubation (T3), and upon leaving the operating room (T4). Additionally, the incidence of adverse reactions such as hypotension, bradycardia, injection pain and postoperative nausea and vomiting (PONV) was recorded. Other outcome measures included the time taken for BIS to decrease to 60, extubation time, time to first postoperative flatus, duration of postoperative hospital stay and frequency of postoperative rescue analgesia. Results During the induction period, there were statistically significant differences in the incidence of hypotension among the Group P, Group R, and Group C [28.9% (13/45) vs 6.7% (3/45) vs 15.6% (7/ 45), χ²=7.966, P=0.019], with the Group P showing a higher incidence than that in the Group R (χ²=7.601, P= 0.006). From intubation to before skin incision, the incidence of hypotension in the Group P was 68.9% (31/45), which was higher than that in the group C at 42.2% (19/45) and the Group R at 26.7% (12/45) (P<0.017). MAP in Group R at T1 and T2 was higher than those in Group P (P<0.05), and MAP at T2 in Group R was also higher than that in Group C (P<0.05). Heart rate in Group R at T1 and T2 was higher than that in Group C and Group P. Compared with Group C and Group P, Group R had longer time for BIS to decrease to 60 and longer extubation time (P<0.05). There was no statistically significant difference in time to first postoperative flatus, duration of postoperative hospital stay and frequency of postoperative rescue analgesia among the three groups (P>0.05). The incidence of PONV in Group R was higher than that in Group C and Group P (P<0.017). The incidence of injection pain in Group R and Group C was lower than that in Group P (P<0.017). Conclusion Remimazolam exhibits the most prominent advantage in hemodynamic stability among the three drugs, but shows subprominent performance in terms of postoperative resuscitation and PONV. Ciprofol is superior to propofol but inferior to remimazolam in hemodynamic stability, while its performance in postoperative resuscitation, postoperative recovery and PONV is basically consistent with propofol.