Intraoperative Targeted Versus Liberal Blood Pressure Management in Patients Undergoing Off-pump Coronary Artery Bypass Grafting

The goal of this clinical trial is to learn whether two approaches to anesthesia andblood pressure management can improve care for adults having off‐pump coronary arterybypass grafting (OPCAB). OPCAB is a type of heart bypass surgery performed withoutroutinely using a heart‐lung machine.The main questions this study aims to answer are: ‐ Does keeping mean arterial pressure (MAP), a measure of average blood pressure, at65 mm Hg or higher during surgery lower the chance of major complications or deathwithin 30 days after surgery compared with usual clinician‐directed blood pressuremanagement? ‐ Does remimazolam provide more stable blood pressure and heart rate than propofolwhen used to maintain general anesthesia during surgery?The researchers expect that targeted blood pressure management may lower the chance ofmajor postoperative complications. They also expect that remimazolam may provide morestable blood pressure and heart rate than propofol.Researchers plan to enroll 416 adults having elective OPCAB surgery. Participants will berandomly assigned to one of four groups. Each group will receive one of two bloodpressure strategies and one of two medicines for maintaining general anesthesia.Participants will: ‐ Receive either targeted blood pressure management or usual clinician‐directed bloodpressure management during surgery. ‐ Receive either remimazolam or propofol to maintain general anesthesia after the samestandard anesthesia induction. ‐ Have routine monitoring during surgery and assessments during recovery aftersurgery. ‐ Complete follow‐up assessments after surgery, including assessments ofcomplications, recovery, and longer‐term health. Some participants will also provideblood samples for a biomarker substudy.The study will also explore whether the effect of the blood pressure strategy differsdepending on which anesthetic medicine is used.