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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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Sorted by citations
Items 101–126 of 126
Ma, H.-Y., Cai, Y.-H., Zhong, J. W., Chen, J., Wang, Z., Lin, C., Wang, Q., & Liu, H.-C. (2024) · Frontiers in Pharmacology · doi:10.3389/fphar.2024.1373006 · Cited by 1
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“8,9 Maintaining anesthesia with remimazolam can present challenges in patients with long-term benzodiazepine use due to potential tolerance, necessitating careful patient selection.”
Fan, W.-J., & Tan, Q. (2023) · Frontiers in Physiology · doi:10.3389/fphys.2023.1163888 · Cited by 1
“Moreover, effects of the anesthetic drug on the cardiovascular system are also in consideration (Choi et al., 2022).”
BackgroundResearch Progress of Remazolam for General Anesthesia in Elderly Patients
Jiang, X. (2023) · Advances in Clinical Medicine · doi:10.12677/acm.2023.13112553 · Cited by 1
Cho, E., Kim, H. Y., Kim, Y., & Shin, S. (2026) · PLoS ONE · doi:10.1371/journal.pone.0360759
Lee, Y., Park, Y., Park, Y., Kim, S., & Choi, E. (2026) · Journal of International Medical Research · doi:10.1177/03000605261495755
Lúcio, M. J., Ferreira, S., Pereira, M., Barata, C., Correia, J., Mota, L., Abreu, T., Semedo, J., & Aljazeeri, J. (2026) · Pulmonology · doi:10.1080/25310429.2026.2691458
Zhang, Y., Song, Q., Xie, K.-J., Ou, Z.-J., & Mo, L. (2026) · Perioperative Medicine · doi:10.1186/s13741-026-00713-1
“Nonetheless, no significant difference in PONV has been observed between remimazolam and propofol (Matsu-moto et al. 2023; Choi et al. 2022; Kim et al. 2023), which may be due to small sample sizes and an insufficient ability to detect differences.”
Das neue Benzodiazepin Remimazolam und dessen Stellenwert für die Notfallmedizin
Willingshofer, M.-P. (2026) · Anästhesie Nachrichten · doi:10.1007/s44179-026-00366-x
Song, S.-W., Lee, H., Ahn, J., Kim, N., & Lee, S.-H. (2026) · Korean Journal of Anesthesiology · doi:10.4097/kja.25462
“Choi et al. reported reduced pain and analgesic requirements in patients in whom anesthesia was maintained with remimazolam as compare to those in whom propofol was used, with comparable quality of recovery as measured using the QoR-15 [30].”
Self-citationLee, S. C., Chung, C., Ma, S., Choi, S., Park, S. Y., & Lee, T. (2026) · Anesthesia and Pain Medicine · doi:10.17085/apm.24154
“In a recent RCT, general anesthesia with remimazolam was not associated with a higher incidence of postoperative delirium compared with propofol in older patients undergoing ortho-pedic surgery [23].”
Zhou, X., Liu, X.-C., Chen, L., Zhao, L., Mao, W., Zhang, L.-Y., Xie, Y., & Li, L.-J. (2026) · PeerJ · doi:10.7717/peerj.21018
Liu, H., Xing, X., Jiang, F., Zhang, L., & Chen, L. (2026) · Drug Design Development and Therapy · doi:10.2147/dddt.s572431 · Cited by 2
“25,26 Allowing for an anticipated 10% dropout rate, the final target sample size was increased to 126 patients (63 per group).”
Ba, Y., Wang, Y., Dai, L., & Yang, S. (2025) · Frontiers in Medicine · doi:10.3389/fmed.2025.1679322
Pharmacokinetics of Remimazolam Versus Midazolam After Intravenous Administration to Horses
Kawashima, M., Kuroda, T., Minamijima, Y., Yamazaki, Y., Mita, H., Nomura, M., & Ohta, M. (2025) · Journal of Veterinary Pharmacology and Therapeutics · doi:10.1111/jvp.70030
“This suggests that RMZ could be useful for anesthesia in horses, potentially offering benefits such as a fast start and end to effects and a reduced risk of prolonged sedation and residual ataxia, as has been found in humans (Choi et al. 2022; Hung et al. 2024).”
Abdallfatah, A., Beshay, B., Nasseem, M., Tahhan, I. S., Kloub, M., Machchhar, R. R., Daoud, S., Hamed, M., & Abosheaishaa, H. M. (2025) · Perioperative Care and Operating Room Management · doi:10.1016/j.pcorm.2025.100569
Remimazolam in elderly patients undergoing EBUS-TBNA: protocol for a randomized clinical trial
Liu, Y., Chen, Y., Ma, L., Zhang, F., Yang, M., & He, L. (2025) · International Journal of Surgery Protocols · doi:10.1097/sp9.0000000000000058
“Furthermore, remimazolam has been shown to reduce postoperative complications and enhancing recovery quality [ 21 ] .”
Li, H., Li, C., Wei, S.-Y., Shi, H., & Liu, J. (2025) · BMC Anesthesiology · doi:10.1186/s12871-025-03292-8
“Previous studies have yielded mixed findings regarding the incidence of complications; however, in general, remimazolam has not been found to increase postoperative complications when compared to propofol [25, 28–30].”
Nayak, A., Kurian, S. A., Bhandary, A., Misra, K., Nalakath, H., Syamkumarz, V., Attar, J., & Paulose, L. (2025) · Journal of Pharmacy and Bioallied Sciences · doi:10.4103/jpbs.jpbs_1858_24
Liu, H., Zhou, M.-X., Chen, X., Esmaeili, E., Sun, M., & Wu, Z.-L. (2025) · PLoS ONE · doi:10.1371/journal.pone.0319044
“Remimazolam-based total intravenous anesthesia yielded comparable quality of recovery to propofol among female patients receiving thyroid surgery [27].”
Nobukuni, K., Shirozu, K., Maeda, A., Murakami, T., Higashi, M., & Yamaura, K. (2024) · THE JOURNAL OF JAPAN SOCIETY FOR CLINICAL ANESTHESIA · doi:10.2199/jjsca.44.590
Yang, H., Wang, L.-Y., Zhu, K., Shen, L.-L., Wang, L., Huai, D., & Xie, C.-L. (2024) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-024-09045-6
Amraoui, J., Leclerc, G., Jarlier, M., Diaz, J., Guler, R., Demoly, C., Verin, C., Guzer, S. R. D., Chalbos, P., Moussion, A., et al. (2024) · BJA Open · doi:10.1016/j.bjao.2024.100309 · Cited by 2
Lu, C., Kang, Y., Luo, Q.-H., Zhong, F., Cai, Y., Zhang, G., Guo, Z., Zhang, S., Ma, J., & Shu, H. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-073024
Aoki, Y., & Nakajima, Y. (2022) · Journal of Anesthesia · doi:10.1007/s00540-022-03154-4
“However, a recently published randomized trial compared the effect of remimazolam on the quality of recovery-15 score with that of propofol [6].”
BackgroundEffect of Different General Anesthetics on Postoperative Recovery Quality Score in Elderly Patients
Liu, J. (2023) · Advances in Clinical Medicine · doi:10.12677/acm.2023.1392081
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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