Journal Article

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

Choi, Eun Ah, Kwon, Eun Jin, Min, Jeong-Jin, Oh, Eun Jung, Chung, Yoon Joo, Lee, Jong-Hwan, On, Young Keun

2023

Overview

The emergence profiles in patients undergoing total intravenous anesthesia with either propofol or remimazolam with flumazenil reversal were compared. A prospective, double-blind, randomized trial. An operating room and a post-anesthesia care unit (PACU). Adult patients (n = 100) having American Society of Anesthesiologists (ASA) physical status of I-III undergoing general anesthesia were enrolled and randomly assigned to the propofol or the remimazolam group. The propofol group received target-controlled infusion of propofol, and the remimazolam group received continuous infusion of remimazolam. Continuous infusion of remifentanil was used in both groups. For emergence, flumazenil was used in increments of 0.2 mg in the remimazolam group. The primary outcome was the time required for the patient to obey verbal commands. The secondary outcomes included the time to bispectral index (BIS) over 80, the time to laryngeal mask airway (LMA) removal, the Richmond Agitation-Sedation Scale (RASS) scores in the PACU, and adverse events throughout the study period. The time taken to obey verbal commands was significantly longer in the propofol group than the remimazolam group (14 [9, 19]) vs. 5 [3, 7]) minutes, P < 0.001; median difference -9, 95% confidence interval -11 to -6). The times to BIS over 80 and to LMA removal were also significantly longer in the propofol group. In addition, the RASS score upon arrival to the PACU differed significantly between the two groups (P = 0.006). Re-sedation in the PACU was observed in 11 (22%) of the patients in the remimazolam group. Remimazolam-based total intravenous anesthesia with flumazenil reversal may be effective in reducing emergence time, but a significant incidence of re-sedation was observed in the PACU. Further studies are needed to determine adequate dose and timing of routine flumazenil use and minimize the risk of re-sedation. •Remimazolam is a novel ‘ultra-short-acting’ benzodiazepine.•Remimazolam has a short history of use in total intravenous anesthesia.•Remimazolam's effect can be reversed by flumazenil.•Propofol has no specific antagonist.•Remimazolam can provide accelerated emergence after continuous infusion.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Ablation / Airway management / Anesthesia / Blood pressure / Clinical trials / Consciousness / Emergence profile / Flumazenil / General anesthesia / Hypotension / Pain / Pain Medicine / Patient satisfaction / Propofol / Pulse oximetry / Re-sedation / Remimazolam / Respiration / Total intravenous anesthesia / Vital signs