Purpose This study was conducted to compare the efficacy and safety of remimazolam with those of sevoflurane in patients undergoing off-pump coronary artery bypass (OPCAB) surgery. Methods This study was a single-center, retrospective observational study. Adult patients who underwent OPCAB surgery between April 2023 and July 2024 and received sevoflurane or remimazolam for maintenance of general anesthesia were included. The primary outcome was intraoperative average blood pressure (ABP). Secondary outcomes were amounts of norepinephrine and other vasopressors used during surgery, intraoperative heart rate (HR), fluid balance, central venous O