Comparison of Remimazolam-Flumazenil versus Propofol for Rigid Bronchoscopy: A Prospective Randomized Controlled Trial

Abstract

Background: Remimazolam is a novel ultrashort-acting intravenous benzodiazepine sedative–hypnotic that significantly reduces the times to sedation onset and recovery. This trial was conducted to confirm the recovery time from anesthesia of remimazolam-flumazenil versus propofol in patients undergoing endotracheal surgery under rigid bronchoscopy. Methods: Patients undergoing endotracheal tumor resection or stent implantation were randomly allocated into a remimazolam group (Group R) or a propofol group (Group P). The primary outcome was the recovery time from general anesthesia. The secondary outcomes were the time to loss of consciousness (LoC), hemodynamic fluctuations, and adverse events. Results: A total of 34 patients were screened, and 30 patients were enrolled in the study. The recovery time was significantly shorter for Group R (140 ± 52 s) than for Group P (374 ± 195 s) (p < 0.001). The times to LoC were 76 ± 40 s in Group R and 75 ± 25 s in Group P and were not significantly different. There were also no significant differences in hemodynamic fluctuations or adverse events between the two groups. Conclusions: The recovery time from general anesthesia in rigid bronchoscopy patients was shorter using remimazolam-flumazenil than with propofol, with no dramatic hemodynamic fluctuations and adverse events or differences between the agents. Remimazolam-flumazenil allows for faster recovery from anesthesia than propofol.

Comparison of recovery profiles between total intravenous anaesthesia with propofol or remimazolam reversed with flumazenil in patients undergoing breast surgery

“…However, we did not observe any other significant differences between the two groups other aspects of recovery, including NRS scores for pain, opioid and antiemetic requirements, the total QoR-15 scores, and length of PACU stay. Other studies have reported advantages of remimazolam over propofol in promoting early recovery in patients undergoing sedation for procedures, 2,4 or general anaesthesia requiring endotracheal intubation 6,7 . To best of our knowledge, this randomised controlled trial is the first to compare the recovery profiles of general anaesthesia with a supraglottic airway device using either propofol or remimazolam/flumazenil in patients undergoing breast surgery for cancer and with relatively little postoperative pain.…”

“…Other studies have reported advantages of remimazolam over propofol in promoting early recovery in patients undergoing sedation for procedures, 2,4 or general anaesthesia requiring endotracheal intubation. 6,7 To best of our knowledge, this randomised controlled trial is the first to compare the recovery profiles of general anaesthesia with a supraglottic airway device The haemodynamic variables, including heart rate, blood pressure, pulse oximetry and BIS at different time points: before anaesthesia induction (T1), after anaesthesia induction (T2), at the start of surgery (T3), at skin closure (T5) and at the end of surgery (T6). The data points and error bars represent mean and standard deviation, respectively.…”

“…However, studies comparing the effects of propofol and remimazolam on the recovery time from general anaesthesia have provided inconsistent results 7–9 . Although one clinical trial reported a significant reduction in recovery times with remimazolam compared with propofol, 7 noninferiority trials have found no significant differences 8 . Additionally, a multicentre trial showed that patients in the remimazolam group had longer times to eye opening and extubation than those in the propofol group 9 .…”

“…[4][5][6] However, studies comparing the effects of propofol and remimazolam on the recovery time from general anaesthesia have provided inconsistent results. [7][8][9] Although one clinical trial reported a significant reduction in recovery times with remimazolam compared with propofol, 7 noninferiority trials have found no significant differences. 8 Additionally, a multicentre trial showed that patients in the remimazolam group had longer times to eye opening and extubation than those in the propofol group.…”

Remimazolam-based anesthesia with flumazenil allows faster emergence than propofol-based anesthesia in older patients undergoing spinal surgery: A randomized controlled trial

“…In this study, we set up a 0.5 mg single-dose flumazenil protocol based on these reports. [22][23][24] Third, the study could not be blinded to anesthesiologists; therefore, although unlikely, a performance bias may exist. Overall, We anesthesiologists are still inexperienced in the use of remimazolam.…”