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Comparison of remimazolam-based and propofol-based total intravenous anesthesia on postoperative quality of recovery: A randomized non-inferiority trial
Open accessAbstract
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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“Among these trials, 5 were regarded high-quality (18-22) (Figs. 2, 3).”
In the citing paper
“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.”
In the citing paper
“No meaningful change in the results was obtained when the sensitivity analysis and the random-effects model were used (15,17,18,20,22).”
In the citing paper
“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).”
In the citing paper
“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).”
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Liao, Y., Min, J., Wu, Z.-X., & Hu, Z. (2023) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2023.1123089 · Cited by 58
Wu, Q., Xu, F.-C., Wang, J., & Jiang, M. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12237316 · Cited by 53
Cai, Y.-H., Zhong, J. W., Ma, H.-Y., Szmuk, P., Wang, C., Wang, Z., Zhang, X., Dong, L.-Q., & Liu, H. (2024) · Anesthesiology · doi:10.1097/aln.0000000000005077 · Cited by 52
“30 Further research is needed to investigate whether remimazolam as a primary agent for anesthesia would yield favorable postoperative recovery outcomes in children.”
Takaki, R., Yokose, M., Mihara, T., Saigusa, Y., Tanaka, H., Yamamoto, N., Masui, K., & Goto, T. (2024) · British Journal of Anaesthesia · doi:10.1016/j.bja.2024.04.013 · Cited by 45
Zhu, T. (2023) · Pain Physician Journal · doi:10.36076/ppj.2023.26.e761 · Cited by 42
“Two trials with 267 patients reported a decrease in QoR-15 scores at 24 hours postsurgery (20,22).”
Zhang, J.-B., Zhang, J.-X., Wang, Y.-Y., Bai, X.-G., Guo, Q., Liu, W., Li, H., Zhu, F.-Q., Wang, X., Jiang, X.-F., et al. (2023) · Journal of clinical anesthesia · doi:10.1016/j.jclinane.2023.111356 · Cited by 33
Remimazolam and serious adverse events
Kempenaers, S., Hansen, T. G., & de Velde, M. V. (2023) · European Journal of Anaesthesiology · doi:10.1097/eja.0000000000001902 · Cited by 57
Remimazolam: its clinical pharmacology and evolving role in anesthesia and sedation practice
Masui, K. (2024) · Current Opinion in Anaesthesiology · doi:10.1097/aco.0000000000001384 · Cited by 26
“A remimazolam bolus of 0.01 – 0.3 mg /kg did not induce notable injection pain [45].”
BackgroundInfluentialJeon, Y.-G., Kim, S., Park, J., Lee, J., Song, S., Lim, H., & Song, S.-W. (2023) · Medicine · doi:10.1097/md.0000000000036440 · Cited by 26
“[29,30] Further studies involving patients with other comorbidities are required to elucidate the safety profile of remimazolam.”
BackgroundKim, E.-J., Kim, C.-H., Yoon, J.-Y., Byeon, G.-J., Kim, H., & Choi, E.-J. (2023) · BMC Anesthesiology · doi:10.1186/s12871-023-02091-3 · Cited by 26
“[14] compared the quality of recovery between remimazolam and propofol in patients undergoing open thyroidectomy with TIVA.”
BackgroundDuan, J., Ju, X., Wang, X., Liu, N., Xu, S.-Q., & Wang, S.-B. (2023) · Drug Design, Development and Therapy · doi:10.2147/dddt.s419146 · Cited by 25
“11,12 Yang et al reported that remimazolam did not increase the incidence of postoperative agitation.”
Zhang, Z. D., & Wang, X. (2025) · European Journal of Medical Research · doi:10.1186/s40001-025-02632-1 · Cited by 24
“Rima reduces the use of sevoflurane, an inhalation anaesthetic; furthermore, Rima also reduced the nonhepatic and renal metabolism and half-life of sevoflurane [10].”
Liang, Z., Liu, J., Chen, S., Zhao, X., Chen, G.-Z., Xie, Y., Wang, D., Xing, F., Mao, Y.-Y., Zhang, W., et al. (2024) · Journal of clinical anesthesia · doi:10.1016/j.jclinane.2024.111660 · Cited by 23
Ju, J., Lee, D.-J., Chung, J., Lee, S., Cho, Y., Jeon, Y., & Nam, K. (2024) · Journal of clinical anesthesia · doi:10.1016/j.jclinane.2024.111580 · Cited by 22
Xu, H., Chen, Y., Xie, P., Lei, T., Liu, K., Liu, X., Tang, J. B., Zhang, L., Yang, J., & Hu, Z. (2023) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2023.176276 · Cited by 24
Self-citationTang, L., Sun, Y., Hao, X., Sun, X., Xie, C., Wang, T., Hu, C., Lu, Y., & Liu, X.-S. (2023) · BJA Open · doi:10.1016/j.bjao.2023.100237 · Cited by 22
“16 However, these data were not significantly different.”
BackgroundResultInfluentialWhite, P. F. (2022) · Journal of Clinical Anesthesia · doi:10.1016/j.jclinane.2022.110977 · Cited by 22
Yim, S.-H., Choi, C.-I., Park, I., Koo, B., Oh, A.-Y., & Song, I. (2024) · Canadian Journal of Anesthesia/Journal canadien d'anesthésie · doi:10.1007/s12630-024-02735-z · Cited by 21
Lü, L., Chen, B., Zhao, X., Zhai, J., Zhang, P., & Hua, Z. (2024) · Drug Design Development and Therapy · doi:10.2147/dddt.s474275 · Cited by 19
“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…”
BackgroundLi, W., Zhao, J., Hao, R., Wang, S.-J., Chen, M., Liu, H.-J., Qi, L., & Hao, Z.-J. (2023) · Drug Design, Development and Therapy · doi:10.2147/dddt.s425860 · Cited by 19
“42 The severity of hypoxemia depends on both oxygen reserve capacity and the degree of respiratory center depression during sedation.”
Shimizu, T., Takasusuki, T., & Yamaguchi, S. (2023) · Advances in Therapy · doi:10.1007/s12325-023-02615-w · Cited by 19
“compared the quality of recovery (QoR) between remimazolam and propofol anesthesia 1 or 2 days postoperatively [14].”
BackgroundResultLee, S. C., Jung, J., Choi, S., Chung, C., Lee, T., & Park, S. Y. (2023) · Medicina · doi:10.3390/medicina59071197 · Cited by 19
“There are some studies that demonstrate the efficacy and safety of remimazolam in terms of hemodynamic stability [14,15,19].”
BackgroundEfficacy and safety of remimazolam in bronchoscopic sedation: A meta-analysis
Zhou, Y., Zhao, C., Tang, Y.-X., & Liu, J.-T. (2024) · World Journal of Clinical Cases · doi:10.12998/wjcc.v12.i6.1120 · Cited by 18
Matsumoto, A., Satomi, S., Kakuta, N., Narasaki, S., Toyota, Y., Miyoshi, H., Horikawa, Y. T., Saeki, N., Tanaka, K., & Tsutsumi, Y. M. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12165402 · Cited by 18
“Several studies have compared the sedative effects and the postoperative quality of recovery using remimazolam and propofol [30,31].”
BackgroundChoi, 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.”
BackgroundResultEffect of remimazolam for general anesthesia on postoperative nausea and vomiting
Kim, S. Y., Sim, K. M., Na, H.-S., Koo, B., & Shin, H.-J. (2024) · Die Anaesthesiologie · doi:10.1007/s00101-024-01454-w · Cited by 16
Lee, S.-H., Kang, H.-Y., Ahn, Y. N., & You, A. (2023) · Journal of Personalized Medicine · doi:10.3390/jpm13050789 · Cited by 16
“[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.”
MethodJiang, 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
“The patient’s quality of recovery was assessed using the Quality of Recovery-15 (QoR15) scale [14, 17, 18] at 24 h postoperatively.”
MethodFang, 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).”
BackgroundWEGNER, 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
Sim, J., Kim, K. M., Lee, U., Lee, E., Noh, G., & Choi, B. (2025) · Anaesthesia · doi:10.1111/anae.16684 · Cited by 21
“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].”
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.”
BackgroundHung, K.-C., Wang, W., Liu, W.-C., Hsu, C., Huang, Y., Wu, J., & Chen, I. (2024) · Systematic Reviews · doi:10.1186/s13643-024-02660-8 · Cited by 13
“Consequently, 13 RCTs published between 2022 and 2024 involving 1418 patients were included in the systematic review and meta-analysis [32–44].”
BackgroundInfluentialZhang, L., Wang, Z., Liu, Y., Zhang, X., & Wu, Y. (2024) · Drug Design, Development and Therapy · doi:10.2147/dddt.s456675 · Cited by 14
“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.”
ResultLi, 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
“Existing studies have adequately assessed its safety and efficacy, 23–25 while evidence of its effect on POD is limited.”
BackgroundZhou, 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”
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
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
“23,24 28 However, data regarding the use of remimazolam in outpatient gynecological surgeries, particularly in terms of patient satisfaction, are limited.”
BackgroundZhang, 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
Jeon, S., Kim, J., Karm, M.-H., & Kim, J.-T. (2024) · BMC Anesthesiology · doi:10.1186/s12871-024-02526-5 · Cited by 12
Self-citationClinical 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
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
“…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…”
BackgroundLee, 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
“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-citationWang, 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
“However, most of these differences did not exceed the minimal clinically important difference (MCID) of 8 (Choi et al., 2022; Wang et al., 2021).”
BackgroundMethodHung, 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
Huang, L., Liu, H., Zou, X., Ding, J., & Tao, S. (2024) · Advances in Therapy · doi:10.1007/s12325-024-02820-1 · Cited by 11
“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.”
Ri, H.-S., Jeon, S., Yeo, J., Jung, H., Kang, C., & Choo, H. (2025) · Scientific Reports · doi:10.1038/s41598-025-14976-z · Cited by 9
Luo, H., & Tang, Z. (2024) · Biomedical Reports · doi:10.3892/br.2024.1891 · Cited by 11
“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.”
Zhu, C., Xie, R., Qin, F., Wang, N., & Tang, H. R. (2024) · PeerJ · doi:10.7717/peerj.17930 · Cited by 8
Qin, J., 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
“Emergence profiles, key indicators of anesthetic efficacy, influence complications such as postoperative nausea, dizziness, disorientation, recovery time, and patient satisfaction [16, 17].”
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
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
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
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-citationZhang, 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].”
Li, H., Wang, J., Wei, R., & Jiang, Y. (2025) · Frontiers in Pharmacology · doi:10.3389/fphar.2024.1506209 · Cited by 8
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
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.”
BackgroundResultInfluentialLee, J., Han, D.-W., Song, Y., Lee, J., Jeon, S., & Kim, M. (2024) · Journal of Personalized Medicine · doi:10.3390/jpm14040382 · Cited by 8
“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-citationKim, 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
“[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-citationHu, 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
Self-citationZhang, 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
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
Shi, F., Tang, R., Du, X., Li, X., & Wu, G.-S. (2024) · BMC Anesthesiology · doi:10.1186/s12871-024-02466-0 · Cited by 7
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.”
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.”
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.”
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
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
Yunoki, K., & Mima, H. (2023) · Journal of Anesthesia · doi:10.1007/s00540-023-03214-3 · Cited by 5
“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].”
BackgroundModel-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
“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.”
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
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.”
Liu, R., Wang, Z., Meng, Y., Chen, W., & Zhou, M. (2025) · Journal of Investigative Surgery · doi:10.1080/08941939.2025.2500438 · Cited by 3
“Concordantly, in a recently published study, the remimazolam group was noted to have lower pain intensity and analgesic requirement than the propofol group [27].”
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.”
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].”
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].”
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
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.”
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
“Moreover, our study reached the consistent conclusion with previous studies 8,30,31 that remimazolam and propofol have similar effect regarded PONV.”
InfluentialChen, 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
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-citationYang, 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.”
Lee, J. M., Lee, J., Kang, S. H., Jung, K., Yeo, H., & Joo, Y. J. (2025) · Medicina · doi:10.3390/medicina61091721 · Cited by 2
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-citationZhu, J.-X., Cao, Y., Zhang, X.-G., & Xu, B. (2025) · Drug Design, Development and Therapy · doi:10.2147/dddt.s518616 · Cited by 2
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…”
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
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
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
“9,15 Several possible explanations may account for these negative findings.”
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
“These findings are consistent with rapid emergence reported by Choi et al. [26] in thyroid surgery.”
Guerguer, W., Fahaid, A., Benhammou, M., Nounou, M. V., Meng, L., Khalleefah, D. R., Nunez-Rodriguez, E., Cata, J. P., Alawi, Z. S. J., Abuajamieh, M., et al. (2026) · BMC Anesthesiology · doi:10.1186/s12871-026-03787-y · Cited by 1
“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].”
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-citationSafety 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
“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].”
InfluentialEffect 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.”
Wu, J., Cai, S., Wang, C.-M., & Wang, X. (2025) · European Journal of Integrative Medicine · doi:10.1016/j.eujim.2025.102455 · Cited by 1
Metadata
- 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
- Venue
- Journal of Clinical Anesthesia
- Publisher
- Elsevier BV
- Published
- 2022-11
- Volume
- 82
- Pages
- 110955
- ISSN
- 0952-8180 (ISSN-L)
- 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
- Licence
- 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 › Anesthesiology and Pain Medicine › 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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