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Rapid Alertness: A Propensity-score Matched, Prospective Observational Study of Remimazolam vs. Propofol Infusion for
Antonia Kustura1, Lada Lijović1,2, Matea Lončar1
1Department of Anesthesiology, Intensive Care and Pain Management, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.
Objectives:
The demand for procedural sedation is increasing, with propofol remaining a popular choice due to its safety and rapid recovery profile. Remimazolam presents a promising alternative, offering a rapid onset and short duration of action. Its favorable safety profile and suitability for continuous infusion make it particularly advantageous. This study aimed to evaluate recovery times following continuous infusion of remimazolam compared to propofol sedation.
Methods:
A single-center, prospective, observational study was conducted from February to June 2023 and was approved by the Sestre Milosrdnice University Hospital Center Ethics Committee. Ninety American Society of Anesthesiologists II or III patients undergoing infraumbilical orthopedic, vascular, or inguinal hernia repair surgeries under spinal anesthesia were assigned to receive either remimazolam or propofol sedation. Sedation depth was assessed using bispectral index (BIS), Modified Observer's Assessment of Awareness/Sedation Scale, and Richmond Agitation-Sedation Scale. Sedation onset, duration, and recovery times were recorded, alongside dosage adjustments based on target BIS values of 60-80. Propensity score matching was employed to address confounding variables.
Results:
Remimazolam exhibited significantly faster recovery times, with a median time to achieve BIS > 80 of 3.0 min (IQR = 2.5), compared to 6.0 min (IQR = 3.0) for propofol, p < 0.001. Remimazolam achieved satisfactory sedative and amnestic effects at a median continuous dose of 0.2 (0.1) mg/kg/h, with comparable sedation durations. Significant differences were observed in intraoperative memory retention: 40.0% of patients in the propofol group vs. 10.0% in the remimazolam group reported memory of the event, p = 0.017.
Conclusions:
Remimazolam demonstrates superior recovery time and amnestic properties compared to propofol after continuous infusion sedation. Additionally, remimazolam matches or exceeds propofol in efficacy and safety for intraoperative sedation in non-healthy patients undergoing spinal anesthesia.
Insights
Remimazolam offers faster recovery and better amnesia than propofol for procedural sedation. This study found remimazolam superior for intraoperative sedation in non-healthy patients.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Procedural sedation demand is rising, with propofol being a common agent.
- Remimazolam is an emerging alternative with rapid onset and short duration.
Purpose of the Study:
- Compare recovery times after continuous infusion of remimazolam versus propofol.
- Evaluate remimazolam's efficacy and safety in non-healthy patients undergoing spinal anesthesia.
Main Methods:
- Prospective observational study of 90 ASA II/III patients undergoing surgery under spinal anesthesia.
- Patients received either remimazolam or propofol for sedation, with depth monitored by BIS.
- Propensity score matching was used to control for confounding variables.
Main Results:
- Remimazolam showed significantly faster recovery (median BIS > 80 in 3.0 min vs. 6.0 min for propofol, p < 0.001).
- Lower intraoperative memory retention was reported in the remimazolam group (10.0%) compared to propofol (40.0%, p = 0.017).
- Comparable sedation durations and satisfactory effects were achieved with both agents.
Conclusions:
- Remimazolam offers superior recovery times and amnestic properties compared to propofol for continuous infusion sedation.
- Remimazolam is effective and safe for intraoperative sedation in non-healthy patients.
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