Quality of recovery in patients administered remimazolam versus those administered an inhalant agent for the maintenance of general anesthesia: a randomized control trial

Abstract

Background Remimazolam is a novel intravenous benzodiazepine that is appropriate for the maintenance of anesthesia. Quality of recovery is an important component of health care quality, but there is no published randomized control trial focused on the quality of recovery in patients undergoing total intravenous anesthesia with remimazolam. Methods This parallel-group, single-blind randomized control trial at a tertiary care medical center in South Korea was conducted to determine the difference in the quality of recovery between the patients administered remimazolam and those administered an inhalant anesthetic agent. A total of 168 patients aged 19–65 years who underwent elective laparoscopic cholecystectomy or robotic gynecologic surgery were considered for enrollment. Randomization was performed using sealed envelopes containing computer-generated random allocation sequences. Remimazolam was administered for the maintenance of anesthesia in the remimazolam group (Group R), and desflurane was administered in the desflurane group (Group D). The induction protocol and the target value of the bispectral index were identical in both groups. Patients were blinded to the drug that was administered until they finished the postoperative questionnaire. The main outcome measure was the decrement of the QoR-40 score on postoperative day 1 compared to the QoR-40 score on the day before surgery. Results A total of 165 patients were analyzed. The preoperative and postoperative global QoR-40 scores were 183 and 152 (IQR 173–192 and 136–169), respectively. The perioperative decrement of the global QoR-40 score was 29.96 ± 22.49. The decrement of the QoR-40 score was smaller in Group R than in Group D (26.99 versus 32.90, respectively; mean difference 5.91, 95% confidence interval -0.96–12.79). After adjustment for sex, the type of surgery and surgical time, the administration of remimazolam resulted in a 7.03-point (95% CI 0.35–13.72) less decrement of the QoR-40 score than desflurane. There were no severe adverse events in either group. Conclusion Total intravenous anesthesia maintained with remimazolam provides a better quality of recovery than anesthesia maintained with an inhalant agent in patients undergoing laparoscopic surgery. Additionally, postoperative nausea and vomiting were largely reduced with remimazolam. Trial registration KCT0006288, Clinical Research Information Service (CRIS), Republic of Korea Registration date: 23/06/2021

Comparison of postoperative nausea and vomiting between remimazolam and propofol: a propensity score-matched, retrospective, observational, single-center cohort study

“…Hari et al [ 23 ] found that the incidence of early PONV was lower after the administration of remimazolam than after the administration of desflurane in patients undergoing laparoscopic gynecologic surgery. Song et al [ 24 ] also demonstrated that the incidence of early PONV was lower with remimazolam than with desflurane in patients undergoing laparoscopic cholecystectomy or robot-assisted gynecological surgery. These findings, although limited, indicate that PONV is less likely to occur with remimazolam than with inhaled anesthetic agents.…”

Total intravenous anesthesia with remimazolam in a patient with epilepsy who underwent deep brain stimulation: a case report

“…Postoperative nausea and vomiting can be minimized by maintaining anesthesia with remimazolam [14]. The patient did not complain of nausea and vomiting during hospitalization.…”

“…The time to the loss of consciousness following the administration of remimazolam was similar to that of conventional hypnotic agents. The time to emergence of consciousness after cessation of remimazolam administration is usually 10 to 20 minutes [14]. Flumazenil can readily reverse the effect of benzodiazepine when emergence is prolonged or intraoperative awakening of a patient is required.…”

A retrospective comparative study of anesthesia with remimazolam and remifentanil versus dexmedetomidine and remifentanil for transcatheter aortic valve replacement

“…Therefore, prompt and reliable awakening is considered very important for early detection of cranial nerve complications. In addition, remimazolam is reported to be advantageous for postoperative recovery 13) . Clear arousal may also reduce the workload of the physician in charge by providing an opportunity to rule out cranial nerve complications immediately after surgery, which may simplify postoperative patient explanation and patient management.…”