Comparison of Remimazolam versus Sevoflurane on the Postoperative Quality of Recovery in Cervical Spine Surgery: A Prospective Randomized Controlled Double-Blind Trial

Abstract

Remimazolam is a newly developed ultra-short-acting benzodiazepine. We compared overall functional recovery, including the postoperative Quality of questionnaire scores, between balanced inhalational anesthesia using sevoflurane and total intravenous anesthesia (TIVA) with remimazolam in patients undergoing anterior cervical discectomy and fusion (ACDF). Patients and Methods: Seventy-two patients were randomized to the remimazolam (group R) or sevoflurane (group S) group. The primary outcome was the total QoR-15 score on postoperative day (POD) 1. We also assessed the total QoR-15 score on POD2, subscores of the QoR-15, perioperative parameters, and postoperative recovery profiles. Group-time interaction effects on the QoR-15 and its sub-scores were analyzed using a linear mixed model. Results:The total QoR-15 score on POD1 (120.2 in group R vs 114.3 in group S, P=0.189) was not statistically different between the groups. There were no significant group-time interaction effects on total QoR-15 scores. Instead, patients in group R showed significantly better sub-scores in psychological and postoperative nausea and vomiting (PONV) items on POD1, as well as a lower degree of PONV, than those in group S. Among the five dimensions of the QoR-15, a significant group-time interaction effect was observed for psychological support. Group R showed significantly less changeability in blood pressure and heart rate with a lower dose of intraoperatively administered vasopressor than group S. Conclusion: Considering QoR-15, including PONV reduction, and intraoperative hemodynamic stability, remimazolam can be used as the novel and safe anesthetic agent for maintaining general anesthesia instead of sevoflurane in patients undergoing ACDF.

Comparison of Remimazolam Versus Dexmedetomidine on the Quality of Recovery in Functional Endoscopic Sinus Surgery ： A Randomized Clinical Trial

“…Previous studies have validated the effectiveness and reliability of QoR-40 in general surgery patients [8].Furthermore,a study showed that total intravenous anesthesia was more bene cial to physical comfort and physical independence, out of ve dimensions of the QoR-40 questionnaires than inhalation anesthesia [20]. Another study also reported that remimazolam-based anesthesia was more effective than sevo urane-based anesthesia on preventing PONV and improving quality of recovery in cervical spine surgery [21].Additionally,Matsumoto et al has compared the effect on PONV using remimazolam and propofol,and the result showed that there was not signi cant difference in the incidence of PONV [22].Similarly to these results, the incidence of PONV in the groups R and D was lower than in the group C. Despite the fact that otolaryngological procedures without prophylactic antiemetics is considered risk factors for PONV [23], but only 6 and 8 patients had PONV in the groups R and D,respectively. Moreover, intraoperative opioid use has a positive relationship with PONV [24].…”