Clinical Research Directory

Inclusion Criteria: * Age 18 to 85 years * Scheduled for elective liver resection * Preoperative surgical plan includes resection of at least three Couinaud liver segments * Planned use of low central venous pressure management, general anesthesia, invasive arterial pressure monitoring, and central venous pressure monitoring * American Society of Anesthesiologists physical status II or III * Both study anesthesia strategies are considered clinically appropriate * Able to understand the study information and provide written informed consent Exclusion Criteria: * Emergency surgery or inability to complete written informed consent before surgery * Known contraindication or serious hypersensitivity to remimazolam, another benzodiazepine, propofol, or a relevant excipient * Preoperative shock, ongoing vasoactive drug support, or another hemodynamically unstable condition that makes either study anesthesia strategy unsafe * Child-Pugh class C, Model for End-Stage Liver Disease score of 20 or higher, or end-stage liver disease in the investigator's judgment * Massive ascites, recent variceal bleeding, clinically important hypersplenism with severe thrombocytopenia, or portal hypertension sufficient to substantially alter circulatory management * Regular long-term benzodiazepine use, drug dependence, or alcohol misuse expected to affect the pharmacological evaluation * Clinical requirement for an inhalational anesthetic or another maintenance anesthesia strategy incompatible with randomized assignment * Pregnant or breastfeeding * Concurrent participation in another interventional study that may affect the primary outcome * Any other condition that, in the investigator's judgment, makes participation unsafe or prevents completion of the study procedures