AIM: The aim of this study is to evaluate the anesthetic effectiveness and safety of remimazolam tosilate (RT) compared with propofol in elderly patients undergoing hip fracture surgery.

METHODS: This retrospective cohort study analyzed clinical data from patients aged ≥60 years who underwent hip fracture surgery between January 2023 and December 2024 at our center. Patients were divided into two groups based on the anesthetic administered: group remimazolam tosilate (RT) (n = 105) and group propofol (P) (n = 115). Anesthetic efficacy outcomes included the time from the start of induction to achieving a bispectral index (BIS) ≤60 and a Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score ≤3, as well as the time from discontinuation of the anesthetic agent to extubation and discharge from the post-anesthesia care unit (PACU). Safety outcomes included assessments of hemodynamic stability and the incidence of adverse events.

RESULTS: Both groups achieved comparable sedation efficacy (BIS ≤60, MOAA/S ≤3). Group RT exhibited significantly shorter extubation times (7.04 ± 1.41 min vs 12.50 ± 1.76 min, p < 0.001) and PACU discharge times (25.20 ± 3.06 min vs 38.57 ± 4.30 min, p < 0.001). Intraoperative hemodynamic stability was better in the group RT (p < 0.05); however, the intraoperative use of vasopressors (e.g., phenylephrine, ephedrine) and atropine was comparable between the two groups (p > 0.05 for all). The incidence of injection pain was lower in the group RT (5.71% vs 13.91%, p = 0.043).

CONCLUSIONS: RT provides effective anesthesia with faster recovery and enhanced hemodynamic stability compared to propofol in elderly patients undergoing hip fracture surgery. Additionally, its lower incidence of injection pain further supports its safety, suggesting that RT is a promising alternative for anesthesia in this patient population.