Efficacy of remimazolam in preventing postoperative nausea and vomiting: a systematic review and meta-analysis

This meta-analysis aimed to evaluate the efficacy of remimazolam, a newly introduced anesthetic, in preventing postoperative nausea and vomiting (PONV) compared to other anesthetics. A systematic search of studies published up to January 2024 in PubMed, Cochrane Library, and Embase was conducted to identify randomized controlled trials (RCTs) comparing remimazolam with other anesthetics in terms of PONV. Following data synthesis, outcomes were reported as the relative risk (RR) with 95% confidence interval (95% CI). Subgroup analyses were performed according to the type of comparator anesthetic. A total of 50 RCTs involving 9,193 participants were included. The results showed no significant difference in PONV incidence between remimazolam and other anesthetic agents (RR: 0.96, 95% CI: 0.80-1.13, P = 0.607). However, subgroup analysis demonstrated that a lower incidence of overall PONV was associated with remimazolam compared with inhalation anesthetics (n = 363; RR: 0.50; 95% CI: 0.34-0.73; P < 0.001). Conversely, a higher incidence of postoperative vomiting was associated with remimazolam compared with propofol (n = 3,860; RR: 1.41; 95% CI: 1.05-1.90; P = 0.024). Overall, there was no significant difference between remimazolam and other anesthetic agents in preventing PONV. However, subgroup analysis revealed that remimazolam was more effective than inhalation anesthetics in mitigating PONV, and it was inferior to propofol in preventing postoperative vomiting.