Cardiopulmonary Adverse Events of Remimazolam versus Propofol During Cervical Conization: A Randomized Controlled Trial

Abstract

Purpose This study aimed to compare the cardiopulmonary safety of remimazolam and propofol in patients undergoing cervical conization. Methods This was a single-blind, parallel, randomized controlled study. A total of 204 patients scheduled for day surgery of cold knife cervical conization received either remimazolam-alfentanil anesthesia (remimazolam group) or propofol-alfentanil anesthesia (propofol group). The primary outcome was the incidence of intraoperative cardiopulmonary adverse events (a composite outcome of hypotension, bradycardia and hypoxemia). The occurrence of hypotension, bradycardia, hypoxemia and the degree of body movement were secondary outcomes, as well as the moment at which consciousness was lost, the interval between the end of anesthesia and the operating room’s release of the patient, and the overall dosage of alfentanil administered during the procedure. Results The incidence of intraoperative cardiopulmonary adverse events was 45 (44.1%) in the remimazolam group and 72 (70.6%) in the propofol group (absolute risk difference [95% CI], −26.47% [−39.55% to −13.39%]; odds ratio (OR) [95% CI], 0.43 [0.28 to 0.65]; P < 0.001). The remimazolam group showed lower incidences of hypotension and hypoxemia compared to the propofol group ( P = 0.01 for both). No significant differences were observed in the overall alfentanil dosages administered, bradycardia, bodily movement, or time to losing consciousness between the two groups. Conclusion In patients who underwent cold knife cervical conization, remimazolam-alfentanil anesthesia was associated with a reduced incidence of intraoperative cardiopulmonary adverse events compared with propofol-alfentanil anesthesia.

Comment on Matsumoto et al. Remimazolam’s Effects on Postoperative Nausea and Vomiting Are Similar to Those of Propofol after Laparoscopic Gynecological Surgery: A Randomized Controlled Trial. J. Clin. Med. 2023, 12, 5402

“…Furthermore, the occurrence of intraoperative hypotension was not provided, though it was defined in their methods section. The recent work in female patients undergoing cervical conization demonstrates that remimazolam-based general anesthesia is associated with a decreased incidence of intraoperative hypotension compared with propofol-based general anesthesia [7]. Most importantly, intraoperative hypotension has been associated with an increased risk of PONV [8].…”