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Comparison of postoperative nausea and vomiting between Remimazolam and Propofol in Patients undergoing oral and
Eun-Jung Kim1,2, Cheul-Hong Kim1,2, Ji-Young Yoon1,2
1Department of Dental Anesthesia and Pain Medicine, School of Dentistry, Dental Research Institute, Pusan National University, Yangsan, Republic of Korea.
Background:
Remimazolam is a recently approved, ultra-short-acting benzodiazepine. However, few studies have investigated remimazolam in relation to postoperative nausea and vomiting (PONV). This study aimed to compare the effects of remimazolam and propofol on PONV in patients undergoing oral and maxillofacial surgery.
Methods:
Patients (n = 206) aged 19-65 years who were scheduled for oral and maxillofacial surgery were randomized into two groups, the remimazolam (R) and propofol group (P). In the R group (n = 94), remimazolam was used to induce anesthesia at 12 mg/kg/h and to maintain anesthesia at 1-2 mg/kg/h. In the P group (n = 95), anesthesia was induced and maintained with propofol (target effect-site concentration: 3-5 µg/ml). In both groups, remifentanil was administered at a target effect-site concentration of 2.5-4 ng/ml. The primary outcome was the overall incidence of PONV during the first 24 h after surgery. Secondary outcomes included the severity of nausea, use of rescue antiemetics, severity of postoperative pain, use of rescue analgesia, and quality of recovery.
Results:
The incidence of PONV during the first 24 h after surgery was 11.7% and 10.5% in the R group and P group, respectively, and there was no significant difference in the severity of nausea (P > 0.05). Ten patients in the R group and ten patients in the P group required rescue antiemetics during the first 24 h after surgery (P = 0.98). No inter-group differences were observed in terms of postoperative pain score, use of rescue analgesia, and quality of recovery (P > 0.05).
Conclusions:
In this study, remimazolam did not increase the incidence and severity of PONV compared with propofol.
Trial Registration:
KCT0006965, Clinical Research Information Service (CRIS), Republic of Korea. Registration date: 26/01/2022.
Insights
Remimazolam, an ultra-short-acting anesthetic, showed no increase in postoperative nausea and vomiting (PONV) compared to propofol. This study found similar PONV incidence and severity between the two anesthetic agents in oral and maxillofacial surgery patients.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Remimazolam is a novel ultra-short-acting benzodiazepine with limited research on its impact on postoperative nausea and vomiting (PONV).
- Understanding remimazolam's effect on PONV is crucial for optimizing anesthetic management and patient recovery.
- Oral and maxillofacial surgery patients are susceptible to PONV, necessitating comparative studies of anesthetic agents.
Purpose of the Study:
- To compare the incidence and severity of PONV between remimazolam and propofol in patients undergoing oral and maxillofacial surgery.
- To evaluate secondary outcomes including postoperative pain, rescue antiemetic and analgesic use, and quality of recovery.
Main Methods:
- A randomized controlled trial involving 206 patients (aged 19-65) scheduled for oral and maxillofacial surgery.
- Patients were assigned to either the remimazolam group (n=94) or the propofol group (n=95) for anesthesia induction and maintenance.
- The primary outcome was the incidence of PONV within 24 hours post-surgery; secondary outcomes included nausea severity, pain, and recovery quality.
Main Results:
- The incidence of PONV was comparable between the remimazolam group (11.7%) and the propofol group (10.5%), with no significant difference in nausea severity.
- Rates of rescue antiemetic use were similar in both groups (10 patients each).
- No significant inter-group differences were found in postoperative pain, rescue analgesia requirements, or quality of recovery.
Conclusions:
- Remimazolam does not increase the incidence or severity of PONV when compared to propofol in patients undergoing oral and maxillofacial surgery.
- Remimazolam appears to be a viable anesthetic alternative with a similar PONV profile to propofol.
- Further research may explore remimazolam's role in other surgical populations regarding PONV.
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