Comparison of remimazolam-based and propofol-based total intravenous anesthesia on postoperative quality of recovery: A randomized non-inferiority trial

Choi, Jeong Yeon; Lee, Hye Sun; Kim, Ji Young; Han, Dong Woo; Yang, Ju Yeon; Kim, Min Jae; Song, Young

doi:10.1016/j.jclinane.2022.110955

Cited by 133Anesthesia and Sedative AgentsAnesthesia and Pain ManagementNausea and vomiting management

Comparison of remimazolam-based and propofol-based total intravenous anesthesia on postoperative quality of recovery: A randomized non-inferiority trial

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Choi, Jeong Yeon, Lee, Hye Sun, Kim, Ji Young, Han, Dong Woo, Yang, Ju Yeon, Kim, Min Jae, Song, Young·2022·Journal of Clinical Anesthesia

DOI 10.1016/j.jclinane.2022.110955

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Abstract

Study objective The quality of recovery (QoR) of remimazolam-based and propofol-based total intravenous anesthesia was compared as measured by QoR-15 scores. Design A prospective, double-blind, randomized controlled, non-inferiority trial. Setting An operating room, a post-anesthesia care unit (PACU), and a hospital ward. Patients Female patients (n = 140; 20-65 years) scheduled for open thyroidectomy were enrolled and randomly assigned to the remimazolam or propofol group. Interventions The remimazolam group received continuous remimazolam infusions and effect-site target-controlled remifentanil infusions. The propofol group received effect-site target-controlled infusions of propofol and remifentanil. Measurements The primary outcome was QoR-15 on postoperative day 1 (POD1). The mean difference between the groups was compared against a non-inferiority margin of -8. Secondary outcomes were QoR-15 on POD2, hemodynamic data, time to lose and recover consciousness, sedation score upon PACU admission, pain, and postoperative nausea and vomiting profiles at the PACU and ward. Group-time interaction effects in hemodynamic data and QoR-15 were analyzed using a linear mixed model. Main results The total QoR-15 score on POD1 in the remimazolam group was non-inferior to that in the propofol group (mean [SD] 111.2 [18.8] vs. 109.1 [18.9]; mean difference [95% CI] 2.1 [-4.2, 8.5]; p = 0.002 for non-inferiority). The QoR-15 score on POD2 was comparable between the groups, and no group-ti…

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Five of the included trials were regarded as high-quality.
“Among these trials, 5 were regarded high-quality (18-22) (Figs. 2, 3).”
From Hemodynamic Influences of Remimazolam Versus Propofol During the Induction Period of General Anesthesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials (2023) · cites this paper as [20]
There was no statistically significant difference in prevalence of nausea and vomiting between remimazolam and propofol (OR = 1.32; 95% CI, 0.73 to 2.39; I2 = 33%).
“Based on the fixed-effects model, the OR of remimazolam to propofol in the subgroup of nausea and vomiting was 1.32 95% CI, 0.73 to 2.39; I² = 33%) (Fig. 12), indicating that there existed no statistical conspicuous discrepancy in the prevalence of nausea and vomiting between the 2 arms.”
From Hemodynamic Influences of Remimazolam Versus Propofol During the Induction Period of General Anesthesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials (2023) · cites this paper as [20]
No meaningful change in nausea/vomiting results was obtained with sensitivity analysis and random-effects model.
“No meaningful change in the results was obtained when the sensitivity analysis and the random-effects model were used (15,17,18,20,22).”
From Hemodynamic Influences of Remimazolam Versus Propofol During the Induction Period of General Anesthesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials (2023) · cites this paper as [20]
The fixed-effects pooled result for QoR-15 at 24 hours postsurgery showed a difference favoring remimazolam (MD = 5.31; 95% CI, 1.51 to 9.12; I2 = 87%; P = 0.006).
“The pooled result based on only 2 trials with 267 patients conducted with the fixed-effects model yielded a high heterogeneity result (MD = 5.31; 95% CI, 1.51 to 9.12; I² = 87%; P = 0.006] (Fig. 14).”
From Hemodynamic Influences of Remimazolam Versus Propofol During the Induction Period of General Anesthesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials (2023) · cites this paper as [20]
Risk of bias was moderate in 5 papers for other biases because of singular gender or type of surgery.
“The risk of bias was rated as moderate in 5 papers for the domain of other biases because of their singular gender or type of surgery (15,19-22).”
From Hemodynamic Influences of Remimazolam Versus Propofol During the Induction Period of General Anesthesia: A Systematic Review and Meta-analysis of Randomized Controlled Trials (2023) · cites this paper as [20]

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“[29,30] Further studies involving patients with other comorbidities are required to elucidate the safety profile of remimazolam.”
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Comparison of postoperative nausea and vomiting between Remimazolam and Propofol in Patients undergoing oral and maxillofacial surgery: a prospective Randomized Controlled Trial
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“[14] compared the quality of recovery between remimazolam and propofol in patients undergoing open thyroidectomy with TIVA.”
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Effects of Remimazolam and Propofol on Emergence Agitation in Elderly Patients Undergoing Hip Replacement: A Clinical, Randomized, Controlled Study
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“11,12 Yang et al reported that remimazolam did not increase the incidence of postoperative agitation.”
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“Rima reduces the use of sevoflurane, an inhalation anaesthetic; furthermore, Rima also reduced the nonhepatic and renal metabolism and half-life of sevoflurane [10].”
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Remimazolam attenuates myocardial ischemia-reperfusion injury by inhibiting the NF-ĸB pathway of macrophage inflammation.
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Effect of general anaesthesia with remimazolam versus propofol on postoperative quality of recovery in patients undergoing ambulatory arthroscopic meniscus repair: a randomised clinical trial
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“16 However, these data were not signiﬁcantly different.”
BackgroundResultInfluential
Remimazolam - Can it become a cost-effective alternative to propofol for intravenous anesthesia and sedation?
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“17 Considering that remimazolam belongs to the benzodiazepine class of drugs, which may potentially affect sleep, 40 and there is limited existing research on the relationship between intraoperative remimazolam infusion and postoperative sleep quality, we concurrently followed up on the sleep…”
Background
The Efficacy and Safety of Remimazolam Besylate Combined with Esketamine for Outpatient Colonoscopy: A Prospective, Randomized, Controlled Clinical Trial
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“42 The severity of hypoxemia depends on both oxygen reserve capacity and the degree of respiratory center depression during sedation.”
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“compared the quality of recovery (QoR) between remimazolam and propofol anesthesia 1 or 2 days postoperatively [14].”
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Comparison of Postoperative Nausea and Vomiting Incidence between Remimazolam and Sevoflurane in Tympanoplasty with Mastoidectomy: A Single-Center, Double-Blind, Randomized Controlled Trial
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“There are some studies that demonstrate the efficacy and safety of remimazolam in terms of hemodynamic stability [14,15,19].”
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Efficacy and safety of remimazolam in bronchoscopic sedation: A meta-analysis
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“Several studies have compared the sedative effects and the postoperative quality of recovery using remimazolam and propofol [30,31].”
Background
Comparison of hypotension incidence between remimazolam and propofol in patients with hypertension undergoing neurosurgery: prospective, randomized, single-blind trial
Choi, S.-H., Min, K., Park, E. K., & Park, S. (2024) · BMC Anesthesiology · doi:10.1186/s12871-024-02578-7 · Cited by 17
“Choi et al. [24] compared hemodynamic data between remimazolam-and propofol-based TIVA, which, similar to our study, involved administering propofol through TCI and utilizing the manufac-turer-recommended dosage of remimazolam.”
BackgroundResult
Effect of remimazolam for general anesthesia on postoperative nausea and vomiting
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Comparison of the Incidence of Postoperative Acute Kidney Injury Following the Administration of Remimazolam or Sevoflurane in Elderly Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial
Lee, S.-H., Kang, H.-Y., Ahn, Y. N., & You, A. (2023) · Journal of Personalized Medicine · doi:10.3390/jpm13050789 · Cited by 16 · see citing works
“[24] compared RMMZ and propofol and found that the time to tracheal extubation was approximately 600 s without reversal of flumazenil in the RMMZ group.”
Method
Effects of Erector Spinae Plane Block and Transmuscular Quadratus Lumborum Block on Postoperative Opioid Consumption in Total Laparoscopic Hysterectomy: A Randomized Controlled Clinical Trial
Jiang, W., Wang, M., Wang, X., Jin, S.-Y., Zhang, M., Zhang, L.-L., Zhang, Y., & Wu, Y. (2023) · Pain and Therapy · doi:10.1007/s40122-023-00505-1 · Cited by 16 · see citing works
“The patient’s quality of recovery was assessed using the Quality of Recovery-15 (QoR15) scale [14, 17, 18] at 24 h postoperatively.”
Method
The safety and efficacy of remimazolam tosylate for induction and maintenance of general anesthesia in pediatric patients undergoing elective surgery: Study protocol for a multicenter, randomized, single-blind, positive-controlled clinical trial
Fang, Y., Wang, C., Gao, Y.-Q., Cai, Y.-H., Chen, J., Zhang, X.-L., Dong, L.-Q., Shang-Guan, W.-N., & Liu, H.-C. (2023) · Frontiers in Pharmacology · doi:10.3389/fphar.2023.1090608 · Cited by 16
“propofol for general anesthesia in female patients aged 20–65 years undergoing thyroid surgery (Choi et al., 2022).”
Background
Comparison between hemodynamic effects of remimazolam and propofol during general anesthesia: a systematic review and meta-analysis.
WEGNER, B. M., WEGNER, G. M., SPAGNOL, L. W., COSTA, L. A., SPAGNOL, V. W., & PAIVA, D. F. (2024) · Minerva Anestesiologica · doi:10.23736/s0375-9393.24.18041-8 · Cited by 19 · see citing works
Incidence of postoperative delirium and quality of recovery in older patients undergoing gastrectomy under general anaesthesia with remimazolam vs. propofol: a randomised non‐inferiority study
Sim, J.-H., Kim, K. M., Lee, U., Lee, E.-K., Noh, G.-J., & Choi, B.-M. (2025) · Anaesthesia · doi:10.1111/anae.16684 · Cited by 15
“However, studies comparing remimazolam with propofol and sevo ﬂ urane in adults have been conducted, and these have shown that the outcomes with remimazolam are not inferior [37, 38].”
Bolus administration of remimazolam was superior to midazolam for deep sedation in elderly patients undergoing diagnostic bronchoscopy: A randomized, double-blind, controlled trial
Wu, Q., Xu, R., Zhou, X., Wang, L.-F., Sheng, C., Ding, M., & Cao, Y. (2024) · Medicine · doi:10.1097/md.0000000000037215 · Cited by 15
“[6,7] Some studies have confirmed that remimazolam could be safely and effectively used for bronchoscopy and had a faster onset of action and faster recovery of neuropsychiatric functions compared to midazolam.”
Background
Comparing subjective quality of recovery between remimazolam- and propofol-based total intravenous anesthesia for surgical procedures: a meta-analysis
Hung, K.-C., Wang, W.-T., Liu, W.-C., Hsu, C.-W., Huang, Y.-T., Wu, J.-Y., & Chen, I.-W. (2024) · Systematic Reviews · doi:10.1186/s13643-024-02660-8 · Cited by 14 · see citing works
“Consequently, 13 RCTs published between 2022 and 2024 involving 1418 patients were included in the systematic review and meta-analysis [32–44].”
BackgroundInfluential
Comparison of Remimazolam Tosilate and Propofol Sedation on the Early Postoperative Quality of Recovery in Patients Undergoing Day Surgery: A Prospective Randomized Controlled Trial
Zhang, L., Wang, Z., Liu, Y., Zhang, X., & Wu, Y. (2024) · Drug Design, Development and Therapy · doi:10.2147/dddt.s456675 · Cited by 14 · see citing works
“A prior work reported that the quality of postoperative recovery after remimazolam sedation was similar with propofol, 16 and this conclusion is consistent with our trial results.”
Result
Comparison of the effects of remimazolam tosylate and propofol on postoperative delirium among older adults undergoing major non-cardiac surgery: protocol for a randomised controlled trial
Li, H.-X., Li, B.-L., Wang, T.-H., Xu, X., Wang, F., Zhang, X., Zhang, X., Li, H.-Y., Mu, B., Sun, Y.-L., et al. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-071912 · Cited by 14 · see citing works
“Existing studies have adequately assessed its safety and efficacy, 23–25 while evidence of its effect on POD is limited.”
Background
Effect of Remimazolam Supplementation on Propofol Requirements During Hysteroscopy: A Double-Blind, Dose-Response Study
Zhou, Y.-H., Li, S.-X., Li, L., Deng, C.-M., Shen, J.-J., Wang, D.-X., Chen, X.-Z., & Xu, L.-L. (2024) · Anesthesia and Analgesia · doi:10.1213/ane.0000000000006921 · Cited by 13
“E”
Effects of Esketamine Combined with Dexmedetomidine on Early Postoperative Cognitive Function in Elderly Patients Undergoing Lumbar Spinal Surgery: A Double-Blind Randomized Controlled Clinical Trial
Tao, Q.-Y., Liu, D., Wang, S.-J., Wang, X., Ouyang, R.-N., Niu, J.-Y., Ning, R.-D., & Yu, J.-M. (2024) · Drug Design, Development and Therapy · doi:10.2147/dddt.s481173 · Cited by 12 · see citing works
Comparing Remimazolam and Propofol for Postoperative Anesthesia Satisfaction in Outpatient Gynecological Surgery: A Randomized Clinical Trial
Wang, X.-L., Dai, L.-L., Li, Y.-N., Zhang, J.-W., Qu, M.-C., Zhou, Y., & Xing, N. (2024) · Drug Design, Development and Therapy · doi:10.2147/dddt.s483029 · Cited by 12 · see citing works
“23,24 28 However, data regarding the use of remimazolam in outpatient gynecological surgeries, particularly in terms of patient satisfaction, are limited.”
Background
Etomidate Combined with Propofol versus Remimazolam for Sedation in Elderly Patients During Gastrointestinal Endoscopy: A Randomized Prospective Clinical Trial
Zhang, Q., Zhao, R., Wu, Y.-Q., Zhang, L.-M., & Feng, Y. (2024) · Drug Design, Development and Therapy · doi:10.2147/dddt.s454314 · Cited by 12
Effect of converting from propofol to remimazolam with flumazenil reversal on recovery from anesthesia in outpatients with mental disabilities: a randomized controlled trial
Jeon, S., Kim, J., Karm, M.-H., & Kim, J.-T. (2024) · BMC Anesthesiology · doi:10.1186/s12871-024-02526-5 · Cited by 12
Self-citation
Clinical Application and Research Progress of Remimazolam for Pediatric Patients
Bai, C., Xu, M., Guo, Y., Jin, Y.-W., & Zhao, X. (2024) · Drug Design, Development and Therapy · doi:10.2147/dddt.s453440 · Cited by 12 · see citing works
Comparison of recovery profiles between total intravenous anaesthesia with propofol or remimazolam reversed with flumazenil in patients undergoing breast surgery
Lee, J., Kim, D. H., Ju, J., Nam, K., Cho, Y., Jeon, Y., & Lee, S. (2024) · European Journal of Anaesthesiology · doi:10.1097/eja.0000000000001951 · Cited by 12 · see citing works
“…trial reported a signiﬁcant reduction in recovery times with remimazolam compared with propofol, 7 noninferiority trials have found no signiﬁcant 8 9 variability in the stimuli provided to patients during emergence, or the lack of ﬂumazenil. the patients’ emergence from anaesthesia and…”
Background
Comparison of Remimazolam versus Sevoflurane on the Postoperative Quality of Recovery in Cervical Spine Surgery: A Prospective Randomized Controlled Double-Blind Trial
Lee, J., Han, D.-W., Kim, N., Kim, K., Yang, Y., Yang, J., Lee, H., & Kim, M. (2024) · Drug Design, Development and Therapy · doi:10.2147/dddt.s441622 · Cited by 12 · see citing works
“18 Conversely, another study showed that the postoperative total QoR-15 scores were significantly lower in remimazolam-based than in propofol-based TIVA in urologic minor surgery.”
BackgroundResultInfluentialSelf-citation
The effect of different nerve block strategies on the quality of post‐operative recovery in breast cancer patients: A randomized controlled study
Wang, S., Shi, J., Dai, Y.-K., Zhang, J., Liu, Q., Yang, P., & Zhu, N. (2023) · European Journal of Pain · doi:10.1002/ejp.2178 · Cited by 12 · see citing works
“However, most of these differences did not exceed the minimal clinically important difference (MCID) of 8 (Choi et al., 2022; Wang et al., 2021).”
BackgroundMethod
Influence of Intravenous Magnesium Sulfate Infusion on the Subjective Postoperative Quality of Recovery: A Meta-Analysis of Randomized Controlled Trials
Hung, K.-C., Chang, L.-C., Ho, C., Hsu, C.-W., Wu, J.-Y., Lin, Y.-T., & Chen, I.-W. (2024) · Nutrients · doi:10.3390/nu16142375 · Cited by 11
Adverse Drug Events Observed with the Newly Approved Remimazolam in Comparison to Propofol for General Anesthesia in Patients Undergoing Surgery: A Meta-analysis
Huang, L., Liu, H., Zou, X., Ding, J., & Tao, S. (2024) · Advances in Therapy · doi:10.1007/s12325-024-02820-1 · Cited by 11 · see citing works
“Following this assessment of the eligible studies, further studies were eliminated as a result of the following reasons: Finally, 16 studies [15–30] were selected for this analysis as shown in Fig.”
Efficacy of remimazolam in preventing postoperative nausea and vomiting: a systematic review and meta-analysis
Ri, H., Jeon, S., Yeo, J., Jung, H., Kang, C., & Choo, H. (2025) · Scientific Reports · doi:10.1038/s41598-025-14976-z · Cited by 10 · see citing works
Efficacy and safety of remimazolam vs. propofol for general anesthesia with tracheal intubation: Systematic review and meta‑analysis
Luo, H., & Tang, Z.-L. (2024) · Biomedical Reports · doi:10.3892/br.2024.1891 · Cited by 10 · see citing works
“A total of seven studies (19,20,23,25,26,29,32), including a total of 777 patients, investigated the incidence of nausea or vomiting.”
Comparison of the recovery quality between remimazolam and propofol after general anesthesia: systematic review and a meta-analysis of randomized controlled trials
Zhu, C.-Y., Xie, R., Qin, F., Wang, N.-G., & Tang, H. (2024) · PeerJ · doi:10.7717/peerj.17930 · Cited by 10 · see citing works
Emergence profiles of remimazolam-flumazenil versus propofol in pediatric general anesthesia for strabismus correction: a randomized clinical trial
Qin, J.-L., Gan, W., Liu, Q., Zhang, X., Li, X., Lu, B., & Shen, Q. (2025) · BMC Anesthesiology · doi:10.1186/s12871-025-03050-w · Cited by 9 · see citing works
“Emergence profiles, key indicators of anesthetic efficacy, influence complications such as postoperative nausea, dizziness, disorientation, recovery time, and patient satisfaction [16, 17].”
Seizure after flumazenil reversal for total intravenous anaesthesia with remimazolam versus propofol: a matched retrospective cohort analysis of a large Japanese nationwide inpatient database.
Komatsu, S., Isogai, T., Makito, K., Matsui, H., Fushimi, K., & Yasunaga, H. (2025) · British Journal of Anaesthesia · doi:10.1016/j.bja.2024.11.046 · Cited by 9
Effect of Continuous Erector Spinae Plane Block on Postoperative Recovery in Patients Undergoing Minimally Invasive Cardiac Surgery: A Prospective, Randomized Controlled Clinical Trial
Lin, J., Yu, Y., Miao, P., Huang, Y., Yu, S., & Guo, K. (2024) · Current Medical Science · doi:10.1007/s11596-024-2593-4 · Cited by 13 · see citing works
Effect of Remimazolam on Induction and Maintenance of General Anesthesia in Kidney Transplant Patients
Chen, L., Qin, W., Wu, J.-D., Zhao, G., Jiang, X., Li, M., Huang, Z.-J., & Du, X.-K. (2024) · International Journal of General Medicine · doi:10.2147/ijgm.s464530 · Cited by 9
Assessment of explicit and implicit memories during remimazolam anaesthesia using the process dissociation procedure
Kim, K. M., Bang, J., Choi, B.-M., & Noh, G.-J. (2023) · European Journal of Anaesthesiology · doi:10.1097/eja.0000000000001904 · Cited by 9
Remimazolam: another option for induction of general anesthesia?
Lee, H.-C. (2022) · Korean Journal of Anesthesiology · doi:10.4097/kja.22692 · Cited by 9
Self-citation
The Recovery of Ciprofol, Remimazolam and Remimazolam-Flumazenil for General Anesthesia Undergoing Fundus Surgery: A Single-Center, Prospective, Randomized, Controlled Clinical Study
Zhang, S., Liu, Y.-F., Liu, Y.-Y., & Xu, T. (2025) · Drug Design, Development and Therapy · doi:10.2147/dddt.s512431 · Cited by 8
“4,5,15,20,21 A recent report showed that the planned incorporation of flumazenil in remimazolam-based TIVA resulted in a significantly faster recovery than that of propofol in patients undergoing endoscopic variceal ligation under general anesthesia.”
Remimazolam alleviates hepatic ischemia-reperfusion injury by activating FOXO1/3 signaling
Zhou, B., Liu, J., Jin, L., & Huang, X.-L. (2025) · BMC Gastroenterology · doi:10.1186/s12876-025-03820-3 · Cited by 8
“Compared to propofol, RMZL exhibits stronger injection pain intensity and analgesic effects [30], as well as a lower risk of bradycardia, hypotension, and respiratory depression [31, 32].”
Median effective dose of remimazolam combined with sufentanil for inhibiting laryngeal mask airway insertion responses in children of different ages
Li, H., Wang, J., Wei, R., & Jiang, Y. (2025) · Frontiers in Pharmacology · doi:10.3389/fphar.2024.1506209 · Cited by 8
Clinical study on the safety and efficacy of remimazolam in hysteroscopic surgery under general anesthesia in elderly patients
Xie, M.-J., Zeng, F.-R., Tian, Q., Deng, H., & Tao, S. (2024) · Frontiers in Medicine · doi:10.3389/fmed.2024.1409233 · Cited by 8
Comparative study on the impact of remimazolam and sevoflurane on quality of recovery after transurethral resection of bladder tumor: A randomized controlled noninferiority study
Ryu, K.-H., Lee, S. H., Shim, J.-G., Park, J., Ahn, J., Jeon, S., & Cho, E. (2024) · Medicine · doi:10.1097/md.0000000000038962 · Cited by 8
“24] Therefore, these studies have incorporated remifentanil equally in both groups and are designed to specifically compare the influence of the anesthetic agents on the QoR score.”
BackgroundResultInfluential
Quality of Postoperative Recovery in Total Intravenous Anesthesia between Remimazolam and Propofol for Intraoperative Neurophysiological Monitoring: A Prospective Double-Blind Randomized Controlled Trial
Lee, J., Han, D.-W., Song, Y., Lee, J., Jeon, S., & Kim, M. (2024) · Journal of Personalized Medicine · doi:10.3390/jpm14040382 · Cited by 8 · see citing works
“While most minimal clinically important differences (MCIDs) reported in various studies fell below 8 points for the total QoR-15 score [7,28], our observed 13-point difference could signify substantial clinical improvement in functional recovery beyond the MCID criteria [24].”
BackgroundResultInfluentialSelf-citation
Effects of Remimazolam Anesthesia with Two Induction Doses on Hemodynamics and Recovery Profile in Older Patients: Comparison with Propofol Anesthesia
Kim, T. K., Kwak, H., Jung, W., Choi, G. B., Park, S. Y., & Kim, J. Y. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12165285 · Cited by 8 · see citing works
“[20] found that patients were more heavily sedated upon admission to the postoperative care unit after remimazolam anesthesia than after propofol anesthesia (20–65 years).”
BackgroundSelf-citation
Bibliometric Analysis of Global Trends in Remimazolam-Related Research Over the Past 15 Years: Compared with Propofol
Hu, X.-Y., Wang, B.-B., Hu, L., Han, D.-S., & Wu, J. (2023) · Drug Design, Development and Therapy · doi:10.2147/dddt.s411829 · Cited by 8 · see citing works
Self-citation
Opioid-Free Anesthesia Improved the Quality of Recovery After Thyroidectomy Through Pre-Emptive and Preventive Analgesia: A Randomized Controlled Trial
Zhang, Y., Xian, X., Wang, F.-R., Zhou, B., Wang, Y., Wang, P.-L., Li, Y., & Wu, Y. (2025) · Drug Design, Development and Therapy · doi:10.2147/dddt.s520856 · Cited by 7
The Effect of Postoperative Tranexamic Acid and Dexamethasone on Quality of Recovery After Arthroscopic Rotator Cuff Repair: a Double-Blinded, Randomized Controlled Trial
Jiang, X.-P., Xu, C., Yuan, C., Gao, W., Liu, W.-C., Wang, Y.-F., Wang, H.-M., Yu, W., & He, Y. (2025) · Journal of Pain Research · doi:10.2147/jpr.s497297 · Cited by 7
Application of remimazolam-0.6% sevoflurane anesthesia for flash visual evoked potential monitoring during pituitary adenoma resection: a non-inferiority randomized controlled trial
Shi, F., Tang, R., Du, X.-R., Li, X., & Wu, G. (2024) · BMC Anesthesiology · doi:10.1186/s12871-024-02466-0 · Cited by 7
Comparison of Remimazolam and Propofol on Post-Induction Hypotension in Elderly Hypertensive Patients: A Randomized Controlled Trial
Zhou, C., Wang, X., Zhou, M.-Y., Guo, S., Qi, Y., Sun, J., & Wang, L.-W. (2025) · Drug Design, Development and Therapy · doi:10.2147/dddt.s510431 · Cited by 6
“33,34 The observed advantage may be attributed to the anti-inflammatory properties of remimazo-lam, which potentially attenuate systemic inflammatory and stress responses, thereby enhancing postoperative recovery quality.”
Comparison of Preoperative Topical Magnesium Sulfate Spraying and Magnesium Sulfate Gargling for the Prevention of Postoperative Sore Throat after Tracheal Intubation: A Randomized, Double-Blind, Non-Inferiority Trial
Wang, L.-X., Liu, Y., Li, F., Qiu, Q., Xiong, X., & Wang, G. (2025) · Drug Design, Development and Therapy · doi:10.2147/dddt.s502081 · Cited by 6
“…outcome measures included the incidence of coughing at extubation; the occurrence of nausea and vomiting after surgery; the occurrence of dysphagia after surgery; the occurrence of hoarseness at T1-T6; and the scores on the 15-item Quality of Recovery Scale (QoR-15) 32 at 48 hours postoperatively.”
Comparison of the recovery profiles of propofol, dexmedetomidine, and remimazolam for intraoperative sedation in patients undergoing upper limb surgery under brachial plexus blockade: a randomized controlled trial
Kim, H., Kim, Y., Lee, J., Jeong, D., Shin, Y., Ro, Y., Kim, H., & Koh, W. (2025) · Canadian Journal of Anesthesia/Journal canadien d'anesthésie · doi:10.1007/s12630-025-02987-3 · Cited by 5
“10,11 Although there are a few studies on the recovery proﬁles after the use of remimazolam for endoscopic procedures, research on intraoperative sedation using remimazolam is scarce.”
Electroencephalogram Correlates of Delayed Emergence After Remimazolam-Induced Anesthesia Compared to Propofol.
Lee, Y., Park, S., Kim, H., Park, Y., Lee, U., Kwon, J., Koo, B.-N., & Moon, J. (2025) · Anesthesia and Analgesia · doi:10.1213/ane.0000000000007516 · Cited by 5
Adverse event signal analysis of remimazolam using the FDA adverse event reporting system database
Liu, H.-T., Li, Z., Yan, S., & Ming, S. (2025) · Acta Anaesthesiologica Scandinavica · doi:10.1111/aas.14588 · Cited by 5 · see citing works
Impact of propofol and sevoflurane anesthesia on cognition and emotion in gastric cancer patients undergoing radical resection
Li, A., Bu, S., Wang, L., Liang, A.-J., & Luo, H.-C. (2024) · World Journal of Gastrointestinal Oncology · doi:10.4251/wjgo.v16.i1.79 · Cited by 5
Postoperative nausea and vomiting after artificial joint replacement surgery: comparison between remimazolam and sevoflurane, a propensity score analysis
Yunoki, K., & Mima, H. (2023) · Journal of Anesthesia · doi:10.1007/s00540-023-03214-3 · Cited by 5 · see citing works
“On the other hand, Choi et al. reported in their prospective, double-blind, randomized controlled, non-inferiority trial that there were no significant differences in PONV between remimazolam and propofol anesthesia in patients undergoing open thyroidectomy [17].”
Background
Model-Informed Precision Dosing of Remimazolam in General Anesthesia Patients
Chen, Y.-T., Zhang, Z., Zhang, X.-F., Peng, Y., Jiao, Z., & Wu, J.-X. (2025) · Drug Design, Development and Therapy · doi:10.2147/dddt.s495604 · Cited by 4 · see citing works
“3,4 A previous study 5 has shown that during non-cardiac surgery, compared with propofol, remimazolam has less effect on hemodynamics during the induction phase of anesthesia, with fewer patients experiencing hypotension.”
Safety and efficacy of remimazolam in mechanical ventilation in the ICU: a protocol for systematic evaluation and meta-analysis
Yang, X., Yang, Y.-L., Miao, G., Yang, C., Liu, L., & Lei, X.-Y. (2024) · BMJ Open · doi:10.1136/bmjopen-2024-091172 · Cited by 4 · see citing works
Comparison of prophylaxis strategy for postoperative nausea and vomiting and its incidence before and after the implementation of 5-hydroxytryptamine 3 in surgical setting: a single-center, retrospective study
Hirai, S., Ida, M., & Kawaguchi, M. (2024) · Journal of Anesthesia · doi:10.1007/s00540-024-03327-3 · Cited by 4
“Remimazolam is available in several Asian countries, including Japan, Korea, and China, which is not listed in the American guideline and its effects on PONV have been controversial [7–9]; thus, patients anesthetized with remimazolam were excluded.”
Effectiveness Analysis of Sevoflurane Combined with Propofol or Remimazolam Anesthesia in Pediatric Laparoscopic Inguinal Hernia Repair and Its Impact on Hemodynamics and Postoperative Pain
Liu, R., Wang, Z.-Y., Meng, Y.-Y., Chen, W., & Zhou, M. (2025) · Journal of investigative surgery · doi:10.1080/08941939.2025.2500438 · Cited by 3 · see citing works
“Concordantly, in a recently published study, the remimazolam group was noted to have lower pain intensity and analgesic requirement than the propofol group [27].”
Recovery Profiles and Well‐Being Outcomes in Patients Undergoing Various Anaesthesia Techniques: A Systematic Review
Bubshait, A. K. (2025) · Health Science Reports · doi:10.1002/hsr2.70937 · Cited by 3
“However, Choi et al. [21] compared the effectiveness of remimazolam ‐ based total intravenous anesthesia and propofol and found propofol was less effective in recovery after surgery as compared to the other.”
Increased Incidence of Postoperative Nausea and Vomiting With Remimazolam Compared to Propofol Following Breast Surgery: A Single-Center, Retrospective Cohort Study
Ryo, M., Hayashi, T., Miyasaka, K. W., Yonekura, Y., Fujita, N., & Abe, S. (2025) · Cureus · doi:10.7759/cureus.86592 · Cited by 3
“Contrary to our findings, other studies have reported no difference in the incidence of PONV between remimazolam and propofol [14-16].”
Comparison of Postoperative Nausea and Vomiting Between Sedation with Remimazolam and Dexmedetomidine in Transcatheter Aortic Valve Replacement Patients: A Single-Center Retrospective Observational Study
Mino, T., Kitaura, A., Sakamoto, H., Yoshino, Y., Tsukimoto, S., Yuasa, H., & Nakajima, Y. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14051759 · Cited by 3
“In studies comparing remimazolam and propofol, higher incidence rates of PONV were found with remimazolam [15,16], whereas others have suggested that remimazolam and propofol did not increase the frequency of PONV [17–19].”
Effect of combination of remimazolam and sevoflurane on elderly patients’ recovery quality from general anesthesia after laparoscopic abdominal surgery: a randomized controlled trial
Lai, X., Liu, S., Wang, D., Chi, Y., Su, X., Guo, L., Zhang, Z., & Xie, H. (2025) · Perioperative Medicine · doi:10.1186/s13741-025-00501-3 · Cited by 3
Comparison of remimazolam-based and propofol-based general anaesthesia on postoperative quality of recovery in patients undergoing laparoscopic sleeve gastrectomy: protocol for a prospective, randomised, parallel-group, non-inferiority trial
An, D.-J., Wang, J., Ren, C., Zhao, Y., Wei, C.-W., & Wu, A. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-093144 · Cited by 3
“24 Additionally, Zhao et al conducted a comparative study between remimazolam and propofol in elderly patients undergoing thoracoscopic laparoscopic radical oesophagectomy, demonstrating that the remimazolam group exhibited more stable haemodynamics and a lower incidence of adverse reactions.”
Effect of Remimazolam- Vs Propofol-Based Intravenous Anesthesia on Surgical Stress Response and Post-Operative Immune Function in Patients with Gastric Radical Surgery
Xu, Q.-Q., Cheng, X., Sun, H., Su, G.-R., Fei, Y., Wang, C., & Han, C. (2024) · Drug Design, Development and Therapy · doi:10.2147/dddt.s489167 · Cited by 3 · see citing works
“Moreover, our study reached the consistent conclusion with previous studies 8,30,31 that remimazolam and propofol have similar effect regarded PONV.”
Influential
The effect of remimazolam versus propofol on respiratory depression for non-intubated general anesthesia: a randomized controlled trial.
Chen, Y., Li, S., Wang, D., Zhang, W., Jiang, C., Su, N., & Bi, C. (2026) · Journal of Anesthesia · doi:10.1007/s00540-026-03722-y · Cited by 2 · see citing works
What Is the Most Effective Strategy for Acute Postoperative Pain in Total Knee Arthroplasty—Retrospective Observational Study
Joo, J., Kim, M., Lee, J., & Koh, H. J. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14228138 · Cited by 2
“However, it has been reported to exert an indirect analgesic effect by attenuating pain-related stress responses through sedation at appropriate doses [10,34,35].”
Self-citation
Comparison of Ciprofol-Based and Propofol-Based Total Intravenous Anesthesia on Postoperative Recovery Quality in Patients Undergoing Hysteroscopic Surgery: A Randomized Non-Inferiority Trial
Yang, H., Yang, Y., Huang, Y., Liu, T., & Wang, Y. (2025) · Drug Design, Development and Therapy · doi:10.2147/dddt.s543281 · Cited by 2
“26 In the present study, as expected, the QoR-15 score was lower at postoperative 24 h than on preoperative day 1, indicating that further recovery is needed after the initial postoperative period.”
Comparative Effects of Remimazolam and Propofol on Intraoperative Hypertension and Hypotension During Robot-Assisted Laparoscopic Gynecologic Surgery: A Retrospective Analysis
Lee, J.-M., Lee, J., Kang, S.-H., Jung, K.-H., Yeo, H., & Joo, Y. (2025) · Medicina · doi:10.3390/medicina61091721 · Cited by 2 · see citing works
Influence of Remimazolam and Propofol on Intraoperative Motor Evoked Potentials During Spinal Surgery: A Randomized Crossover Trial
Kim, B., Kim, H.-B., Kim, M. S., Lim, B. G., & Oh, S. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14155491 · Cited by 2
Self-citation
Development and Validation of a UHPLC-MS/MS Method for Ciprofol Detection in Plasma: Application in Clinical Pharmacokinetic Studies
Zhu, J.-X., Cao, Y., Zhang, X.-G., & Xu, B. (2025) · Drug Design, Development and Therapy · doi:10.2147/dddt.s518616 · Cited by 2
Comparison of the effects of remimazolam and dexmedetomidine on the quality of recovery in functional endoscopic sinus surgery: a randomized clinical trial
Li, Y., Zhou, H.-M., Gao, F., Guan, Q.-Q., Wang, S.-B., Tan, Y. ‐., & Hu, S.-H. (2024) · BMC Anesthesiology · doi:10.1186/s12871-024-02860-8 · Cited by 2
“In addition, Choi et al. [10] reported that the QoR by remimazolam-based total intravenous anaesthesia was not inferior to that by propofol-based total intravenous anaesthesia and that remimazolam lowered pain intensity and analgesic consumption more than did propofol,the reason might be linked to…”
Effects of ciprofol infusion on hemodynamics during induction and maintenance of anesthesia and on postoperative recovery in patients undergoing thoracoscopic lobectomy: Study protocol for a randomized, controlled trial
Guo, N., Cao, J., Duan, M., Zhou, F.-N., Wang, W., Xu, L., Wei, C., & Song, X. (2024) · PLoS ONE · doi:10.1371/journal.pone.0305478 · Cited by 2 · see citing works
Year 2023 in review - General anaesthesia
Bláha, J., Bartošová, T., & Nguyenová, Q. G. (2023) · Anesteziologie a Intenzivni Medicina · doi:10.36290/aim.2023.068 · Cited by 2
Year 2022 in review - Anaesthesia
Blaha, J. (2022) · Anesteziologie a Intenzivni Medicina · doi:10.36290/aim.2022.041 · Cited by 2
Efficacy of Remimazolam for Anesthesia in Patients Undergoing Renal Allograft Transplantation: A Randomized Controlled Trial
Han, M.-M., Sun, D.-D., Lu, D.-J., Huang, X., Kang, F., & Li, J. (2026) · Drug Design, Development and Therapy · doi:10.2147/dddt.s611432 · Cited by 1 · see citing works
“9,15 Several possible explanations may account for these negative findings.”
Effect of remimazolam on postoperative delirium in elderly patients undergoing laparoscopic radical resection for colorectal cancer: a randomized controlled trial
Xu, S., Wan, Q., Li, T., Shu, Y., Guo, Y., & Li, J. (2026) · BMC Gastroenterology · doi:10.1186/s12876-026-04961-9 · Cited by 1 · see citing works
“These findings are consistent with rapid emergence reported by Choi et al. [26] in thyroid surgery.”
Remimazolam-based total intravenous vs. sevoflurane-based balanced general anesthesia on perioperative outcomes in adult surgical patients: a systematic review and meta-analysis
Guerguer, W., Fahaid, A., Benhammou, M., Nounou, M., Meng, L., Khalleefah, D., Nunez-Rodriguez, E., Cata, J., Alawi, Z., Abuajamieh, M., et al. (2026) · BMC Anesthesiology · doi:10.1186/s12871-026-03787-y · Cited by 1 · see citing works
“For instance, it has been shown to be non-inferior to propofol in maintaining higher blood pressure and heart rate, with fewer patients requiring vasopressors during general anesthesia [3–5].”
Target-Controlled Infusion with PSI- and ANI-Guided Sufentanil Versus Remifentanil in Remimazolam-Based Total Intravenous Anesthesia for Postoperative Analgesia and Recovery After Laparoscopic Subtotal Gastrectomy: A Randomized Controlled Study
Jun, B., Yoo, Y. C., Bai, S., Shin, H., Kim, J., Kim, N., & Moon, J. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14248921 · Cited by 1
“These properties make it an attractive alternative to propofol for TIVA, avoiding injection pain and risks associated with long-term infusion [14,15].”
Self-citation
Safety of Remimazolam in Vulnerable Populations
Ge, J.-Y., Deng, B.-R., Cao, X.-H., & Liu, X.-J. (2025) · Drug Design, Development and Therapy · doi:10.2147/dddt.s536873 · Cited by 1 · see citing works
“33 Further research indicated that remimazolam may facilitate earlier extubation following valve replacement surgery when compared to sevoflurane [6.5 (5.1–8.1) min vs 14.2 (10.9–15.9) min; difference in medians, −6.9 min; 95% confidence interval, −8.7 to −5.0; P = 0.001].”
Influential
Effect of remimazolam in non-intubated video-assisted thoracic surgery: a retrospective cohort study
Huang, P.-Y., Ke, H.-H., Cheng, H.-W., Hsu, P., Chang, W.-K., & Ting, C.-K. (2025) · BMC Anesthesiology · doi:10.1186/s12871-025-03131-w · Cited by 1
“…and maintenance at 1 mg/kg/h provided satisfactory anesthesia [15] Our results are consistent with prior research demonstrating that remimazolam is non-inferior to propofol, [16] with fewer respiratory events, further supporting its use in NIVATS to enhance respiratory safety and patient outcomes.”
Exploring the sedation effect of music intervention and remimazolam in elderly patients undergoing transurethral prostate resection under spinal anesthesia: A randomized controlled clinical trial
Wu, J., Cai, S., Wang, C.-M., & Wang, X.-S. (2025) · European Journal of Integrative Medicine · doi:10.1016/j.eujim.2025.102455 · Cited by 1 · see citing works

Authors: Choi, J. Y., Lee, H. S., Kim, J. Y., Han, D. W., Yang, J. Y., Kim, M. J., & Song, Y.
Affiliations: Yonsei University (KR)
Corresponding author: Song, Young
ORCID: Lee, Hye Sun
Kim, Ji Young
Han, Dong Woo
Kim, Min Jae
Song, Young
Venue: Journal of Clinical Anesthesia
Publisher: Elsevier BV
Published: 2022-11
Volume: 82
Pages: 110955
ISSN: 0952-8180 (ISSN-L)
DOI: 10.1016/j.jclinane.2022.110955
OpenAlex: W4293242992
Cited by: 133
References: 33
Citations by year: 2026: 14 · 2025: 38 · 2024: 49 · 2023: 28 · 2022: 4
FWCI: 33.56
Type: journal article
Language: en
Open access: green
ir.ymlib.yonsei.ac.kr
Licence: cc-by-nc-nd
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
doi.org/10.15223/policy-017 (stm-asf)
doi.org/10.15223/policy-037 (stm-asf)
doi.org/10.15223/policy-012 (stm-asf)
doi.org/10.15223/policy-029 (stm-asf)
doi.org/10.15223/policy-004 (stm-asf)
Locations: Journal of Clinical Anesthesia (publishedVersion)
PubMed (publishedVersion)
YUHSpace (Yonsei University Medical Library) (submittedVersion, cc-by-nc-nd)
Topics: Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
Health Sciences › Medicine › Surgery › Nausea and vomiting management
Keywords: remimazolam, propofol, total intravenous anesthesia, quality of recovery, QoR-15, open thyroidectomy, remifentanil, target-controlled infusion, postoperative pain, postoperative nausea and vomiting, hemodynamic stability, post-anesthesia care unit, non-inferiority, female patients, sedation, analgesic requirement, recovery time
MeSH terms: Remifentanil, Anesthesia Recovery Period, Anesthesia, General, Anesthesia, Intravenous, Benzodiazepines, Female, Humans, Prospective Studies, Propofol, Anesthetics, Intravenous

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Comparison of remimazolam-based and propofol-based total intravenous anesthesia on postoperative quality of recovery: A randomized non-inferiority trial

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