Objective  To explore the effect of different doses of remimazolam on patients undergoing unilateral biportal endoscopic discectomy (UBED).

Methods  The data of patients who underwent UBED in the Department of Joint, Hangzhou Fuyang Hospital of TCM Orthopedics and Traumatology from January 2021 to July 2024 were retrospectively collected. According to the anesthesia scheme, the patients were divided into a low-dose group (sufentanil + 0.2 μg/kg remimazolam anesthesia), a medium-dose group (sufentanil + 0.3 μg/kg remimazolam anesthesia), and a high-dose group (sufentanil+0.4 μg/kg remimazolam anesthesia). The three groups were compared in terms of extubation time, post-anesthesia cure unit (PACU) stay time; heart rate (HR), mean arterial pressure (MAP) and respiratory rate (RR) after admission (T1), while grinding of facet joints (T2), nucleus pulposus removal (T3), and completion of surgery (T4), serum neuron-specific enolase (NSE) and S100 calcium-binding protein β (S100β) levels before and 24 hours after surgery, and the incidence of adverse reactions.

Results  A total of 80 patients were included, including 27 patients in the low-dose group, 27 patients in the medium-dose group, and 26 patients in the high-dose group. The time to achieve anesthesia in the high-dose group was significantly less than that in the low-dose and medium-dose group (P<0.05), and the time to achieve anesthesia in the medium-dose group was significantly less than that in the low-dose group  (P<0.05); the time to extubation and PACU stay time in the high-dose group was significantly more than that in the low- dose and medium-dose group (P<0.05), and the time to extubation and PACU stay time in the medium-dose group was significantly more than that in the low-dose group (P<0.05). The HR, MAP, and RR of the high-dose group were significantly lower than those of the low-dose group at T2, T3, and T4 (P<0.05), but there was no significant difference in HR, MAP, and RR between the high-dose group and the medium-dose group  (P>0.05). The NSE and S100β levels of the three groups increased significantly 24 hours after surgery compared with those before surgery (P<0.05), but there was no significant difference among the three groups (P>0.05). There was no significant difference in the incidence of adverse reactions to anesthesia among the three groups (P>0.05).

Conclusion  Remimazolam has an ideal sedative effect in patients undergoing UBED. The dose of 0.3 μg/ kg achieves a balance between anesthesia speed and hemodynamic stability, but the PACU stay time is still significantly more than that of 0.2 μg/kg. Individualized dose selection is required for clinical application.

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