Comparison of postoperative nausea and vomiting between Remimazolam and Propofol in Patients undergoing oral and maxillofacial surgery: a prospective Randomized Controlled Trial

Abstract

Background Remimazolam is a recently approved, ultra-short-acting benzodiazepine. However, few studies have investigated remimazolam in relation to postoperative nausea and vomiting (PONV). This study aimed to compare the effects of remimazolam and propofol on PONV in patients undergoing oral and maxillofacial surgery. Methods Patients (n = 206) aged 19–65 years who were scheduled for oral and maxillofacial surgery were randomized into two groups, the remimazolam (R) and propofol group (P). In the R group (n = 94), remimazolam was used to induce anesthesia at 12 mg/kg/h and to maintain anesthesia at 1–2 mg/kg/h. In the P group (n = 95), anesthesia was induced and maintained with propofol (target effect-site concentration: 3–5 µg/ml). In both groups, remifentanil was administered at a target effect-site concentration of 2.5-4 ng/ml. The primary outcome was the overall incidence of PONV during the first 24 h after surgery. Secondary outcomes included the severity of nausea, use of rescue antiemetics, severity of postoperative pain, use of rescue analgesia, and quality of recovery. Results The incidence of PONV during the first 24 h after surgery was 11.7% and 10.5% in the R group and P group, respectively, and there was no significant difference in the severity of nausea (P > 0.05). Ten patients in the R group and ten patients in the P group required rescue antiemetics during the first 24 h after surgery (P = 0.98). No inter-group differences were observed in terms of postoperative pain score, use of rescue analgesia, and quality of recovery (P > 0.05). Conclusions In this study, remimazolam did not increase the incidence and severity of PONV compared with propofol. Trial registration KCT0006965, Clinical Research Information Service (CRIS), Republic of Korea. Registration date: 26/01/2022.

Comparison of Postoperative Nausea and Vomiting Incidence between Remimazolam and Sevoflurane in Tympanoplasty with Mastoidectomy: A Single-Center, Double-Blind, Randomized Controlled Trial

“…To the best of our knowledge, few studies have compared the incidence of PONV between remimazolam and other intravenous anesthetics. According to Kim et al [ 28 ], there was no significant difference in the incidence and the severity of PONV between using remimazolam and propofol as intravenous anesthetics. Further studies will need to be conducted to justify the usefulness of remimazolam in reducing the incidence of PONV compared to other anesthetics.…”

Comparison of Remimazolam–Flumazenil versus Propofol for Recovery from General Anesthesia: A Systematic Review and Meta-Analysis

“…Upon reviewing the full-text articles of the remaining records, we excluded 13 studies for various reasons: they were not randomized controlled trials [32][33][34][35][36][37], did not set up a propofol group [38,39], did not have routine flumazenil usage in the remimazolam group [19,[40][41][42], or did not have outcomes we wanted [43]. Ultimately, nine studies meeting the criteria were included [44][45][46][47][48][49][50][51][52]. The selection process is illustrated in Figure 1.…”

“…set up a propofol group [38,39], did not have routine flumazenil usage in the remimazolam group [19,[40][41][42], or did not have outcomes we wanted [43]. Ultimately, nine studies meeting the criteria were included [44][45][46][47][48][49][50][51][52]. The selection process is illustrated in Figure 1.…”

“…Each study included both males and females, with patients' American Society of Anesthesiologists (ASA) Classification ranging from 1 to 4. At the study level, each of the nine trials involved different procedures, but all patients received general anesthesia with either a laryngeal mask airway (LMA) [46][47][48] or tracheal intubation [44,45,[49][50][51][52]. Eight studies administered flumazenil routinely after discontinuation of remimazolam, and one study had two remimazolam groups [46], one with flumazenil and one without.…”

“…Additionally, two studies used flumazenil after discontinuation of propofol [49,52]. In the included studies, flumazenil was administered immediately after remimazolam discontinuation [45,47,[49][50][51][52], 10 min after remimazolam discontinuation [46], when the Train of Four (TOF) > 90% [48], or upon the restoration of spontaneous breathing [44]. Following the discontinuation of anesthesia, seven studies employed neuromuscular blockade reversal agents [44][45][46][47][48][49]51], with only one study utilizing opiate receptor antagonists [46].…”