{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T15:48:28Z","timestamp":1782920908014,"version":"3.54.5"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with abdominal sepsis or septic shock undergoing urgent source-control surgery are highly susceptible to anesthetic-induced hypotension, often requiring vasopressors that may stabilize mean arterial pressure (MAP) but worsen microcirculatory perfusion. This retrospective single-center study evaluated whether remimazolam-based general anesthesia reduces perioperative vasopressor burden and improves hemodynamic stability and postoperative outcomes compared with propofol induction followed by volatile maintenance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this study, 220 consecutive Sepsis-3\u2013defined patients who underwent abdominal surgery between January 2021 and June 2025 were analyzed, using a prospectively maintained database. Patients were categorized as propofol\/volatile anesthesia (Group C,\n                      <jats:italic>n<\/jats:italic>\n                      = 116) or remimazolam induction and maintenance (Group R,\n                      <jats:italic>n<\/jats:italic>\n                      = 104). The primary outcome was the Vasopressor-Inotrope Score (VIS) at postoperative intensive care unit (ICU) admission; secondary outcomes included intraoperative hemodynamics across six time points, change in Sequential Organ Failure Assessment at 24 h, ICU\/hospital length of stay (LOS), mortality, and complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In a matched cohort (87 per group), VIS at ICU admission was lower with remimazolam (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.006), accompanied by shorter ICU LOS (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.008) and hospital LOS (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.012), lower in-hospital mortality (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.007), and fewer hospital-acquired infections (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.048), with no differences in mechanical ventilation duration, 30-day mortality, acute kidney injury, acute respiratory distress syndrome, delirium, major complications, or ICU readmission. Mixed-effects models showed more favorable intraoperative systolic blood pressure\/MAP and heart-rate trajectories with remimazolam (significant group-by-time interactions).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Remimazolam-based anesthesia was associated with greater hemodynamic stability and reduced postoperative vasopressor needs, translating to lower resource utilization and in-hospital mortality in septic surgical patients undergoing surgery, supporting prospective trials to test causality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1838670","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T15:14:44Z","timestamp":1782918884000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Remimazolam-based anesthesia in sepsis patients: a retrospective cohort study of hemodynamic stability and postoperative outcomes"],"prefix":"10.3389","volume":"13","author":[{"given":"Hyunyoung","family":"Seong","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sejong","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Korea University College of Medicine","place":["Seoul, Republic of Korea"]},{"name":"Department of Anesthesiology and Pain Medicine, Korea University College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeon Jae","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woohyun","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun Ah","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jang Eun","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University College of Medicine","place":["Seoul, Republic of 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