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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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“30 Further research is needed to investigate whether remimazolam as a primary agent for anesthesia would yield favorable postoperative recovery outcomes in children.”
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“Two trials with 267 patients reported a decrease in QoR-15 scores at 24 hours postsurgery (20,22).”
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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