Postoperative Emergence After Remimazolam- Versus Propofol-Based Total Intravenous Anesthesia for Cardiac Valve...

Remimazolam is an ultra-short-acting benzodiazepine used for general anesthesia, including cardiac surgery; however, its effect on postoperative emergence following cardiopulmonary bypass remains unclear.

We aimed to compare postoperative emergence following remimazolam- and propofol-based total intravenous anesthesia in adult patients undergoing cardiac valve surgery.

A retrospective observational study.

We included adult patients who underwent elective cardiac valve replacement surgery at a single center between April 2023 and September 2024. Patients received either remimazolam- or propofol-based total intravenous anesthesia according to institutional practice. The primary endpoint was postoperative emergence time. Secondary endpoints included time to extubation and early postoperative hemodynamic stability assessed using the vasoactive-inotropic score.

Baseline characteristics and perioperative variables were compared between the groups. Univariate and multivariable linear regression analyses were performed.

Sixty-three patients were included in the analysis (remimazolam group, n = 21; propofol group, n = 42). Postoperative emergence time did not differ significantly between the two groups (164 [120-253] min vs. 137 [95-188] min, P = 0.193). Time to extubation was also comparable between the groups (1,009 [914-1,070] min vs. 1,033 [906-1,057] min, P = 0.844). Early postoperative hemodynamic parameters, including vasoactive-inotropic scores, were comparable between the two groups.

In adult patients undergoing cardiac valve surgery, postoperative emergence time was comparable between remimazolam- and propofol-based total intravenous anesthesia. More prospective studies are warranted to clarify the role of remimazolam in cardiac anesthesia.