Increased Incidence of Postoperative Nausea and Vomiting With Remimazolam Compared to Propofol Following Breast...

Background Postoperative nausea and vomiting (PONV) is a common postoperative complication. This study compared the incidence of PONV between anesthesia management with remimazolam versus propofol in breast surgery patients. Methods This retrospective study included 413 female patients who underwent breast surgery. Patients were divided into the remimazolam group (R group, n=79) and the propofol group (P group, n=334). The primary outcome was the difference in the incidence of PONV within the first two hours (<2h) and between two to 24 hours (2-24h) after surgery. Additionally, the study evaluated risk factors for PONV and the difference in the rate of postoperative rescue antiemetic use between the two groups. Results Incidence of PONV was significantly higher in the R group compared to the P group at <2h (8 (10.1%) vs. 9 (2.7%), 95% CI of difference 18.5%-40.7%, p=0.007), and at 2-24h (30 (38%) vs. 28 (8.4%), 95% CI of difference 0.6%-14.3%, p<0.001). Logistic regression analysis revealed anesthesia management with remimazolam (odds ratio, OR 7.27, 95% CI 3.34-15.8, p<0.001) was a significant risk factor for PONV 2-24h after surgery. During the first two hours after surgery, use of remimazolam was not a significant risk factor. However, it demonstrated a higher odds ratio than other factors (OR 3.22, 95% CI 0.95-10.9, p=0.06). In an exploratory analysis, the use of flumazenil appeared to increase PONV. Conclusion In breast surgery, management with remimazolam resulted in a higher incidence of PONV compared to propofol 2-24h postoperatively. Use of flumazenil may also have an influence on PONV.