Difference between remimazolam toluenesulfonic acid and propofol in waking quality and conscious state after general anesthesia

Abstract

ObjectiveTo explore the difference of anesthesia recovery and postoperative conscious state between remimazolam toluenesulfonic acid and propofol after induction and maintenance of general anesthesia.Methods104 patients undergoing elective tracheal intubation general anesthesia in our hospital were randomly divided into 2 groups: Remimazolam Toluenesulfonic acid group (Group R) and Propofol group (Group P). MOAA/S score, the modified Aldrete score, recovery index, time point, a state of consciousness, interpretative vital signs and adverse events were monitored at different time.ResultsCompared with the Group P, the extubation time and orientation recovery time of the Group R were significantly shorter. When the operation time was less than 1 hour, the MOAA/S score of the Group R was shorter than that of Group P at 5 min and 15 min after the operation. To compare with the Group P, the score of MOAA/S in the Group R increased at 5 min, 20 min and 30 min after the operation. When the operation time was less than or equal to 1 h, the modified Aldrete score in the Group R was slightly higher than that in the Group P at 30 min after extubation. There was no injection pain in the the Group R, and the incidence of hypotension was lower than that of propofol.ConclusionCompared with Propofol, when the operation time of general anesthesia is more than 1 hour, recovery time of Remimazolam Toluenesulfonic acid is shorter, with more complete and higher‐quality recovery.

The use of remimazolam versus propofol for induction and maintenance of general anesthesia: A systematic review and meta-analysis

“…Our results demonstrated no difference in extubation time (MD = −4.59 min, 95% CI -12.31 to 3.13, p = 0.24; I 2 = 98%; four RCTs; n = 485) (Supplementary Figure S3A) (Doi et al, 2020;Li et al, 2021a;Tang et al, 2021;Shi et al, 2022) and time to eye opening (MD = −1.12 min, 95% CI -7.38 to 5.14, p = 0.73; I 2 = 100%; three RCTs; n = 405) (Supplementary Figure S3B) (Doi et al, 2020;Li et al, 2021a;Shi et al, 2022) between the two groups. The incidence of PONV was available in five trials (Li et al, 2021a;Dai et al, 2021;Tang et al, 2021;Hari et al, 2022;Shi et al, 2022), which demonstrated comparable risk of PONV in both groups (RR = 0.82, 95% CI: 0.26 to 2.6, p = 0.74, I 2 = 0%, five trials, 419 participants) (Supplementary Figure S4). While subgroup analysis showed no significant impact of the type of surgery on extubation time and PONV, it was not performed on time to eye opening as only trials of non-cardiac surgery were available.…”

“…Our results showed a significantly lower risk of hypotension associated with the use of remimazolam than that with propofol [Risk ratio (RR) = 0.57, 95% CI: 0.43 to 0.75, p < 0.0001, I 2 = 12%, five trials, 564 participants) (Figure 3) (Doi et al, 2020;Li et al, 2021a;Dai et al, 2021;Liu et al, 2021;Shi et al, 2022). Compared with propofol, the use of remimazolam as an induction agent correlated with a higher heart rate [Mean difference (MD) = 4.26 beats/minutes, 95% CI: 0.01 to 8.51, p = 0.03, I 2 = 61%, four trials, 265 participants] (Supplementary Figure S1) (Dai et al, 2021;Liu et al, 2021;Hasegawa et al, 2022;Shi et al, 2022).…”

“…Following the exclusion of 42 duplicates and 250 articles deemed unsuitable Frontiers in Pharmacology frontiersin.org according to titles and abstracts from the 305 potentially relevant records retrieved from the databases, 13 potentially eligible studies were subjected to full-text review. After removing five more studies based on our exclusion criteria, eight randomized controlled trials (RCT) published from 2020 to 2022 involving 738 patients were included in the current meta-analysis (Doi et al, 2020;Li et al, 2021a;Dai et al, 2021;Liu et al, 2021;Tang et al, 2021;Hari et al, 2022;Hasegawa et al, 2022;Shi et al, 2022). The characteristics of the included studies are demonstrated in Table 1.…”

“…Although all studies compared remimazolam with propofol during anesthetic induction, the doses and administration techniques of remimazolam varied. While remimazolam was administered as bolus doses of 0.2 mg/kg and 0.3 mg/kg in two ( Li et al, 2021a ; Shi et al, 2022 ) and three ( Dai et al, 2021 ; Liu et al, 2021 ; Tang et al, 2021 ) trials, respectively, it was given as continuous infusion at a dosage of 12 mg/kg/h in three studies ( Doi et al, 2020 ; Hari et al, 2022 ; Hasegawa et al, 2022 ). The dosages of propofol also varied in the control group with a maximal dosage of 2.5 mg/kg ( Table 1 ).…”

“…All studies were published in the English language. Of the eight included trials, five were conducted in China ( Li et al, 2021a ; Dai et al, 2021 ; Liu et al, 2021 ; Tang et al, 2021 ; Shi et al, 2022 ) and three were reported from Japan ( Doi et al, 2020 ; Hari et al, 2022 ; Hasegawa et al, 2022 ).…”