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Published on: September 24, 2020

Remimazolam versus Sevoflurane for Paediatric Circumcision: A Randomised Controlled Trial Evaluating Emergence

Yi Zhang1, Shuang Guo1, Linyun Wang2

  • 1Department of Anesthesiology, Maternal and Child Health Hospital of Wanzhou District, Chongqing, People's Republic of China.

Drug Design, Development and Therapy
|May 13, 2026
PubMed
Abstract

Insights

Remimazolam monotherapy significantly reduced emergence delirium in children by 67% compared to sevoflurane anesthesia. This volatile-free alternative offers faster recovery and a better family experience, though careful fluid management is advised due to potential hypotension.

Area of Science:

  • Anesthesiology
  • Pediatric Anesthesia
  • Pharmacology

Background:

  • Emergence delirium affects up to 40% of pediatric sevoflurane anesthetics.
  • Remimazolam, an ultra-short-acting benzodiazepine, offers rapid, predictable recovery via esterase metabolism.
  • Investigating remimazolam as a volatile-free alternative to reduce emergence delirium in children.

Purpose of the Study:

  • To evaluate remimazolam monotherapy as a volatile-free anesthetic alternative.
  • To compare the incidence of emergence delirium between remimazolam and sevoflurane.
  • To assess induction and emergence times, and patient/guardian experience.

Main Methods:

  • Prospective, randomized, assessor-blinded trial in 100 children (3-12 years) undergoing circumcision.
  • Randomized 1:1 to remimazolam or sevoflurane anesthesia, both with penile nerve block.
  • Co-primary outcomes: induction and emergence times; Key secondary outcome: emergence delirium (PAED score ≥12).

Main Results:

  • Remimazolam group had significantly lower emergence delirium (12% vs. 36%, P=0.009) and shorter PACU stay (33.4 vs. 40.7 min, P<0.001).
  • Emergence was faster with remimazolam (10.7 vs. 13.5 min, P<0.001), while induction was slower (80.8 vs. 52.3 s, P<0.001).
  • Transient hypotension occurred more in the remimazolam group (12% vs. 2%, P=0.11), but was fluid-responsive. Guardian anxiety was threefold reduced.

Conclusions:

  • Remimazolam monotherapy effectively reduces emergence delirium by 67% compared to sevoflurane.
  • It provides faster recovery and an improved family experience in pediatric anesthesia.
  • Further multicenter trials are recommended to confirm safety and broader applicability, with attention to preoperative fluid management.
Keywords:
anaesthesiaanaesthetics i.v.anaesthetics volatilecomplicationsemergence deliriumpaediatricrandomised controlled trialremimazolamsevoflurane

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