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Effect of remimazolam for general anesthesia on postoperative nausea and vomiting : A systematic review and

Su Yeon Kim1, Kyu Man Sim1, Hyo-Seok Na1,2

  • 1Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 82, Gumiro 173, 13620, Bundang, Seongnam, Gyeonggi, Korea (Republic of).

Die Anaesthesiologie
|September 13, 2024
PubMed
Abstract

Insights

Remimazolam, a novel benzodiazepine, did not increase postoperative nausea and vomiting (PONV) risk compared to propofol. It significantly reduced PONV incidence versus volatile agents, enhancing patient satisfaction.

Area of Science:

  • Anesthesiology
  • Pharmacology

Background:

  • Benzodiazepines are used to mitigate postoperative nausea and vomiting (PONV).
  • Conflicting evidence exists regarding the efficacy of remimazolam, a novel benzodiazepine, in preventing PONV.

Purpose of the Study:

  • To evaluate if remimazolam reduces PONV incidence compared to propofol or volatile anesthetic agents.
  • To assess secondary outcomes including PONV severity, antiemetic use, and patient satisfaction.

Main Methods:

  • A meta-analysis of 11 randomized controlled trials involving 1514 adult patients.
  • Systematic search of PubMed, EMBASE, CENTRAL, and Web of Science databases.
  • Random-effects model used for calculating odds ratios and mean differences; Cochrane RoB2 tool for bias assessment.

Main Results:

  • Remimazolam did not significantly alter overall PONV incidence (16.1% vs. 16.5%).
  • Subgroup analysis revealed a significant PONV reduction with remimazolam versus volatile agents (OR 0.25), but not versus propofol (OR 1.04).
  • Higher participant satisfaction scores were observed with remimazolam; remifentanil use varied between comparisons.

Conclusions:

  • Remimazolam is a safe option regarding PONV risk compared to propofol.
  • Remimazolam demonstrates efficacy in reducing PONV incidence when compared to volatile anesthetic agents.
  • Higher patient satisfaction suggests potential benefits of remimazolam in clinical practice; further trials are warranted.
Keywords:
AntiemeticsBenzodiazepinesPostoperative complicationsPropofolVolatile agents

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