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[Application of Remimazolam in Pediatric Adenoidectomy and Tonsillectomy Anesthesia and Its Effect on Emergence
Insights
Remimazolam (RM) significantly reduced emergence agitation in pediatric adenoidectomy and tonsillectomy patients compared to propofol (PPF). RM also led to faster recovery times and fewer adverse events, demonstrating improved anesthesia safety and quality.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Pediatric adenoidectomy and tonsillectomy are common procedures.
- Emergence agitation is a frequent complication following general anesthesia in children.
- Comparing anesthetic agents is crucial for optimizing pediatric surgical outcomes.
Purpose of the Study:
- To compare the efficacy and safety of remimazolam (RM) versus propofol (PPF) for anesthesia in pediatric adenoidectomy and tonsillectomy.
- To evaluate the impact of RM and PPF on the incidence and severity of emergence agitation.
- To assess various anesthesia-related parameters and postoperative recovery indicators.
Main Methods:
- A randomized controlled trial involving 120 children undergoing adenoidectomy and tonsillectomy.
- Children were allocated to receive either RM or PPF with remifentanil.
- Key outcomes included incidence of emergence agitation, anesthesia duration, vital signs, sedation scores, pain scores, and adverse events.
Main Results:
- The incidence of emergence agitation was significantly lower with RM (5.00%) compared to PPF (18.33%).
- RM group showed shorter anesthesia time, extubation time, wake-up time, and PACU stay.
- RM was associated with lower Pediatric Anesthesia Emergence Delirium (PAED) scores, improved Ramsay sedation and FLACC pain scores, and fewer negative postoperative behavioral changes.
Conclusions:
- Remimazolam (RM) offers improved anesthesia effects and recovery quality for pediatric adenoidectomy and tonsillectomy.
- RM effectively reduces the incidence and severity of emergence agitation with good safety profile.
- RM represents a promising alternative anesthetic agent in pediatric surgical procedures.
Objective:
To evaluate the application of different anesthetic drugs-remimazolam (RM) and propofol (PPF)-in anesthesia for pediatric adenoidectomy and tonsillectomy and its effect on emergence agitation.
Methods:
A total of 120 children undergoing elective adenoidectomy and tonsillectomy under general anesthesia in Xinhua Hospital, Huainan Xinhua Medical Group between December 2022 and August 2024 were enrolled. With a random number table, they were assigned to a PPF group receiving PPF and remifentanil and a RM group receiving RM and remifentanil, with 60 cases in each group. The primary and secondary outcome indicators of the two groups were compared. The primary outcome indicator was the incidence of emergence agitation. Secondary outcome indicators included anesthesia-related parameters, changes in mean arterial pressure (MAP) and heart rate (HR) at different time points during surgery, changes in pediatric anesthesia emergence delirium (PAED) scores at different time points after recovery, changes in Ramsay sedation scores and Face, Legs, Activity, Cry, Consolability (FLACC) pain scores at 2, 4, 12, and 24 hours after surgery, incidence of negative postoperative behavioral changes (NPOBCs) at 7 and 14 days, and adverse events during anesthesia.
Results:
The incidence rate of emergence agitation was lower in the RM group than that of the PPF group (5.00% vs. 18.33%, P < 0.05). The RM group also demonstrated significantly shorter anesthesia time, extubation time, wake-up time, and postanesthesia care unit (PACU) than those in the PPF group (P < 0.05). HR and MAP in the RM group were higher than those in the PPF group at 3 min after induction, at the time of tracheal intubation, during tonsillectomy, and at the end of surgery, with the difference being statistically significant (P < 0.05). The PAED scores at different time points after recovery, Ramsay sedation scores and FLACC scores at 2, 4 and 12 hours after surgery, the incidence of NPOBCs at 7 days after surgery, and the incidence of adverse reactions during anesthesia were lower in the RM group than those in the PPF group, with the difference being statistically significant (P < 0.05).
Conclusion:
RM improves the anesthesia effect and recovery quality of children undergoing adenoidectomy and tonsillectomy, relieves the severity of emergence agitation, reduces the incidence of agitation, and demonstrates good safety.
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