Remimazolam decreased the incidence of early postoperative nausea and vomiting compared to desflurane after laparoscopic gynecological surgery

Hari, Yuki; Satomi, Shiho; Murakami, Chiaki; Narasaki, Soshi; Morio, Atsushi; Kato, Takahiro; Tsutsumi, Yasuo M.; Kakuta, Nami; Tanaka, Katsuya

doi:10.1007/s00540-022-03041-y

Cited by 38 publications

(33 citation statements)

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“…Following the exclusion of 42 duplicates and 250 articles deemed unsuitable Frontiers in Pharmacology frontiersin.org according to titles and abstracts from the 305 potentially relevant records retrieved from the databases, 13 potentially eligible studies were subjected to full-text review. After removing five more studies based on our exclusion criteria, eight randomized controlled trials (RCT) published from 2020 to 2022 involving 738 patients were included in the current meta-analysis (Doi et al, 2020;Li et al, 2021a;Dai et al, 2021;Liu et al, 2021;Tang et al, 2021;Hari et al, 2022;Hasegawa et al, 2022;Shi et al, 2022). The characteristics of the included studies are demonstrated in Table 1.…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

The use of remimazolam versus propofol for induction and maintenance of general anesthesia: A systematic review and meta-analysis

Hung

Illias

et al. 2023

Front. Pharmacol.

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Background: The primary objective of this study was to compare the risk of hypotension, as well as the induction and recovery characteristics between remimazolam and propofol in patients receiving surgery under general anesthesia.Methods: The Embase, Medline, Google scholar, and the Cochrane Library databases were searched from inception to March 2022 for randomized controlled trials The primary outcome was the risk of post-induction hypotension between the two agents, while the secondary outcomes included anesthetic depth, induction efficacy, time to loss of consciousness (LOC), hemodynamic profiles, time to eye opening, extubation time as well as the incidence of injection pain and postoperative nausea/vomiting (PONV).Results: Meta-analysis of eight studies published from 2020 to 2022 involving 738 patients revealed a significantly lower risk of post-induction hypotension with the use of remimazolam compared to that with propofol [risk ratio (RR) = 0.57, 95% confidence interval (CI): 0.43 to 0.75, p < 0.0001, I2 = 12%, five studies, 564 patients]. After anesthetic induction, the anesthetic depth measured by bispectral index (BIS) was lighter in the remimazolam group than that in the propofol group (MD = 9.26, 95% confidence interval: 3.06 to 15.47, p = 0.003, I2 = 94%, five studies, 490 patients). The time to loss of consciousness was also longer in the former compared to the latter (MD = 15.49 s, 95%CI: 6.53 to 24.46, p = 0.0007, I2 = 61%, three studies, 331 patients). However, the use of remimazolam correlated with a lower risk of injection pain (RR = 0.03, 95%CI: 0.01 to 0.16, p < 0.0001, I2 = 0%, three studies, 407 patients) despite comparable efficacy of anesthetic induction (RR = 0.98, 95%CI: 0.9 to 1.06, p = 0.57, I2 = 76%, two studies, 319 patients). Our results demonstrated no difference in time to eye opening, extubation time, and risk of PONV between the two groups.Conclusion: Remimazolam was associated with a lower risk of post-induction hypotension after anesthetic induction compared with propofol with similar recovery characteristics. Further studies are required to support our findings.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/; Identifier: CRD42022320658.

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Section: Search Results and Study Characteristicsmentioning

confidence: 99%

The use of remimazolam versus propofol for induction and maintenance of general anesthesia: A systematic review and meta-analysis

Hung

Illias

et al. 2023

Front. Pharmacol.

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“…As to whether remimazolam itself has a preventive effect on PONV, it has been suggested in the literature that midazolam can reduce the incidence of PONV when applied either at the induction of anesthesia or at the end of surgery [ 25 ]; Midazolam 2 mg given 30 min before the end of surgery can effectively prevent PONV and is equivalent to ondansetron 4 mg. Hari Y et al found that remimazolam reduced the incidence of early postoperative nausea and vomiting compared with desflurane in gynaecological laparoscopic surgery, with no difference for PONV 24 h after surgery [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

“…Author details 1 Department of Anesthesiology, Weifang People' S Hospital, No. 151 Guangwen Street, Kuiwen District, Weifang 261041, China.…”

Section: Authors' Contributionsmentioning

confidence: 99%

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Prevention of postoperative nausea and vomiting after gynaecological day surgery under remimazolam general anesthesia: a randomized double-blind controlled study

Xiao

Zhu

et al. 2022

BMC Anesthesiol

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Purpose To observe the effect of different antiemetic drugs for the prevention of postoperative nausea and vomiting (PONV) after gynaecological day surgery under remimazolam general anesthesia. Methods One hundred ninety-two patients were selected for gynaecological day surgery and randomly divided into three groups: droperidol group (DD group), tropisetron group (DT group) and control group (DC group). Flurbiprofen axetil 50 mg and dexamethasone 5 mg were given intravenously before induction of anesthesia, and 2 min later droperidol 1 mg was given intravenously to the DD group, tropisetron 5 mg to the DT group and saline (5 ml) to the DC group. Induction of anesthesia: remimazolam 6 mg/kg/h was continuously infused until sleep, mivacurium 0.2 mg/kg and alfentanil 20ug/kg were slowly pushed, 3 min later intubation was performed to control breathing. Maintenance of anesthesia: 40ug/kg/h of alfentanil, 1 mg/kg/h of remimazolam continuous infusion. After awakening and extubation, the patient was transferred to the PACU. PONV were recorded in the PACU and an electronic questionnaire was pushed 24 h after surgery. Results The incidence of PONV within the PACU was significantly lower in the DD (14.5%)and DT(26.7%) groups than in the DC(50%) group (p < 0.01), there was no significantly difference between the DT and DD groups. There were no significant difference in the incidence of PONV in 24 h after surgery between the three groups(DD:DT:DC = 44.5%:45.1%:63.8%,p > 0.05). Conclusions Droperidol or tropisetron combined with dexamethasone is superior to dexamethasone alone for the prevention of PONV in the PACU after remimazolam combined with alfentanil anesthesia, with no significant difference in the incidence of PONV in 24 h after surgery.

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“… 50 Remimazolam could reduce the incidence of postoperative nausea and vomiting in the patients after laparoscopic gynaecological surgery under general anaesthesia as compared with desflurane (27% vs 60%, P=0.02) during the early postoperative period. 82 …”

Section: Clinical Usesmentioning

confidence: 99%

Remimazolam: An Updated Review of a New Sedative and Anaesthetic

Hu¹,

Liu²,

Wen³

et al. 2022

DDDT

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Remimazolam (CNS7056) is a novel benzodiazepine for intravenous sedation; it has an ultra-short duration of action and was recently approved for use in procedural sedation and general anaesthesia. It acts on γ-aminobutyric acid type A receptors and is rapidly converted into an inactive metabolite by tissue esterase enzymes. Remimazolam has been successfully used in endoscopic inspection or surgery and general anaesthesia induction and maintenance with fast and predictable onset and recovery times, high procedure success rates, and minor respiratory and hemodynamic fluctuations and without serious drug-related adverse reactions. If needed, the effects of remimazolam can be reversed by flumazenil, which allows prompt termination of sedation. Although remimazolam has great potential for sedation in patients admitted to intensive care units, future studies are needed to evaluate its efficacy and safety in patients requiring sedation for a long period, and numerous studies are warranted to explore the optimal dose in different application scenarios. The review aimed to provide an introduction to the process of remimazolam synthesis and its current clinical uses and future clinical developments.

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Remimazolam decreased the incidence of early postoperative nausea and vomiting compared to desflurane after laparoscopic gynecological surgery

Cited by 38 publications

References 20 publications

The use of remimazolam versus propofol for induction and maintenance of general anesthesia: A systematic review and meta-analysis

The use of remimazolam versus propofol for induction and maintenance of general anesthesia: A systematic review and meta-analysis

Prevention of postoperative nausea and vomiting after gynaecological day surgery under remimazolam general anesthesia: a randomized double-blind controlled study

Remimazolam: An Updated Review of a New Sedative and Anaesthetic

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