Comparison of propofol vs. remimazolam on emergence profiles after general anesthesia: A randomized clinical trial

Oh, Eun Jung; Chung, Yoon Joo; Lee, Jong‐Hwan; Kwon, Eunjin; Choi, Eun Ah; On, Young Keun; Jun, Min

doi:10.1016/j.jclinane.2023.111223

Cited by 12 publications

(20 citation statements)

References 29 publications

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“…Second, significant individual pharmacokinetic variability and the re-emergence of remimazolam effects following flumazenil reversal have been previously documented 32 , 33 . Moreover, although agitation is a well-known complication of flumazenil administration, no such complications were observed following remimazolam anesthesia during electrophysiological studies in our study cohort, similar to previous reports 34 , 35 . Despite these findings, our study confirmed the benefits of flumazenil use in expediting the regaining of consciousness without any instances of re-sedation or agitation.…”

Section: Discussionsupporting

confidence: 92%

Remimazolam-flumazenil provides fast recovery from general anesthesia compared to propofol during radiofrequency catheter ablation of atrial fibrillation

Lee,

Hwang

et al. 2024

Sci Rep

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The optimal anesthetic agent for radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) and its impact on the recovery profiles remain uncertain. We compared the recovery and hemodynamic parameters between the remimazolam-flumazenil and propofol groups during RFCA. Patients were randomized into the remimazolam-flumazenil and propofol groups. The primary outcome measure was the time to eye opening following the discontinuation of anesthetic agents. Secondary outcomes included time to extubation, time to discharge from the operating room, intraprocedural hemodynamic variables and postoperative quality outcomes. Fifty-three patients were included in the final analysis (n = 26 in the remimazolam-flumazenil and n = 27 in the propofol group). The time to eye opening was significantly shorter in the remimazolam-flumazenil group compared to the propofol group (median [interquartile range]: 174 [157–216] vs. 353 [230–483] s, P < 0.001). The mean blood pressure and bispectral index were significantly higher in the remimazolam-flumazenil group compared to the propofol group (mean difference [95% CI], 7.2 [1.7–12.7] mmHg and 6 [3–8]; P = 0.011 and < 0.001, respectively), which were within target ranges in both groups. Other secondary outcomes were comparable between the groups. Consequently, remimazolam emerges as a promising anesthetic agent, characterized by rapid recovery and stable hemodynamics, during RFCA of AF.Trial registration: NCT05397886.

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Section: Discussionsupporting

confidence: 92%

Remimazolam-flumazenil provides fast recovery from general anesthesia compared to propofol during radiofrequency catheter ablation of atrial fibrillation

Lee,

Hwang

et al. 2024

Sci Rep

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“…Remimazolam sedation can be rapidly reversed by flumazenil within 2 minutes [4], allowing for rapid recovery from remimazolam anesthesia. However, Oh et al [11] reported that when a large dose of remimazolam was administered intraoperatively, there might be a rebound increase in remimazolam concentration after flumazenil reversal, potentially leading to re-sedation in patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison of remimazolam tosylate and propofol in patients undergoing general anesthesia using a laryngeal mask airway without muscle relaxants

2024

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It has been reported that anesthesia using propofol can frequently induce hypotension. Herein, we designed this study to compare the incidence of hypotension induced by propofol or remimazolam during laryngeal mask airway (LMA) anesthesia without muscle relaxants. 95 patients aged 18 to 65 years undergoing LMA anesthesia without muscle relaxants were randomly allocated to two groups. After 0.2 µg/kg sufentanil, Group P received a bolus dose of 2 mg/kg propofol followed by a continuous propofol infusion, while Group R received a bolus dose of 0.3 mg/kg remimazolam followed by a continuous remimazolam infusion. The primary outcome was hypotension, defined as systolic blood pressure falling below 90 mmHg during anesthesia. Secondary outcomes included other adverse events. The success rate of initial LMA insertion, LMA insertion conditions, LMA removal time and changes in bispectral index (BIS) and hemodynamics during anesthesia induction, were also assessed. The results showed that the incidence of hypotension was not significantly different between the two groups (47.9% in group P and 36.2% in group R, p = 0.246). However, the BIS and heart rate during induction of anesthesia were significantly higher in group R than in group P (p < 0.05). Also, hiccups were more common in group R than in group P (14.9% vs. 2.1%, p = 0.031), and the LMA removal time was significantly longer in group R than in group P (12 min vs. 8 min, p = 0.001). We did not find a significantly lower incidence of hypotension in patients undergoing LMA anesthesia without muscle relaxants when comparing remimazolam to propofol, potentially related to the study’s small sample size, and conducting a large-scale study using similar conditions could be inappropriate due to the risk of remimazolam-induced hiccups.

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“…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.…”

Section: Search and Selectionmentioning

confidence: 99%

“…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.…”

Section: Search and Selectionmentioning

confidence: 99%

“…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.…”

Section: Study Characteristicsmentioning

confidence: 99%

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

Wu,

Xu,

Wang

et al. 2023

JCM

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(1) Purpose: to systematically evaluate the recovery following sedation and anesthesia with remimazolam combined with flumazenil in comparison to propofol. (2) Methods: Electronic databases, including PubMed, Embase, Web of Science, and the Cochrane Library, were systematically searched from their inception up to 22 October 2023. Included in this analysis were randomized controlled trials (RCT) that compared remimazolam–flumazenil with propofol for the recovery from sedation and anesthesia in adults. The risk of bias was assessed using the Cochrane risk of bias tool. Pooled risk ratios (RR) or mean differences (MD) along with their corresponding 95% confidence intervals (CI) were calculated using either fixed-effects or random-effects models, and the results were visualized in forest plots. (3) Results: Nine RCTs involving 745 patients who underwent general anesthesia in three different countries were included. Compared to propofol, the remimazolam–flumazenil combination shortened the emergence time (MD = −4.34 min, 95% CI = [−6.88, −1.81], p = 0.0008, low certainty), extubation time (MD = −4.26 min, 95% CI = [−6.81, −1.7], p = 0.0011, low certainty), and the post-anesthesia care unit (PACU) stay (MD = −4.42 min, 95% CI = [−7.45, −1.38], p = 0.0044, low certainty), while reducing the incidence of respiratory depression (RR = 0.2, 95% CI = [0.04, 0.89], p = 0.03, high certainty) after general anesthesia. However, this combination was associated with a higher incidence of re-sedation (RR = 4.15, 95% CI = [1.31, 13.13], p = 0.01, moderate certainty). (4) Conclusions: Based on the existing evidence, the combination of remimazolam and flumazenil accelerates recovery from general anesthesia and lowers the risk of respiratory depression compared to propofol. However, it is important to consider the higher risk of re-sedation when using this combination in clinical practice. Due to limitations in the quality of the evidence, it is advisable to interpret the results of meta-analyses with caution.

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Comparison of propofol vs. remimazolam on emergence profiles after general anesthesia: A randomized clinical trial

Cited by 12 publications

References 29 publications

Remimazolam-flumazenil provides fast recovery from general anesthesia compared to propofol during radiofrequency catheter ablation of atrial fibrillation

Remimazolam-flumazenil provides fast recovery from general anesthesia compared to propofol during radiofrequency catheter ablation of atrial fibrillation

Comparison of remimazolam tosylate and propofol in patients undergoing general anesthesia using a laryngeal mask airway without muscle relaxants

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

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