Effect of converting from propofol to remimazolam with flumazenil reversal on recovery from anesthesia in outpatients with mental disabilities: a randomized controlled trial

• Published in: BMC anesthesiology Vol. 24; no. 1; p. 151
• Main Authors: Jeon, Sooyoung, Kim, Jieun, Karm, Myong-Hwan, Kim, Jin-Tae
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 22.04.2024; BioMed Central; BMC
• Subjects: Adult; Analgesics; Anesthesia; Anesthesia Recovery Period; Anesthetics, Intravenous; Benzodiazepines - administration & dosage; Blood pressure; Body mass index; Care and treatment; Clinical trials; Consciousness; Extubation; Fainting; Female; Flumazenil; Flumazenil - therapeutic use; General anesthesia; Hemodynamics; Humans; Length of Stay - statistics & numerical data; Male; Medical research; Medicine, Experimental; Middle Aged; Nausea; Ostomy; Outpatient anesthesia; Outpatients; Palonosetron; Patients; Patients with mental disabilities; Phenols; Postoperative Nausea and Vomiting; Propofol; Recovery of anesthesia; Remifentanil; Remimazolam; Respiration; Surgery; United States > US; Germany; Recovery of anesthesia; Patients with mental disabilities; Flumazenil; Remimazolam; Outpatient anesthesia
• ISSN: 1471-2253; 1471-2253
• DOI: 10.1186/s12871-024-02526-5

General anesthesia is often necessary for dental treatment of outpatients with mental disabilities. Rapid recovery and effective management of postoperative nausea and vomiting (PONV) are critical for outpatients. This study aimed to investigate the effect of transitioning from propofol to remimazolam with flumazenil reversal administered toward the end of surgery during propofol-based total intravenous anesthesia (TIVA) on recovery. Adults with mental disabilities scheduled to undergo dental treatment were randomly assigned to receive either propofol-based TIVA (Group P) or propofol-remimazolam-based TIVA with flumazenil reversal (Group PR). Propofol was replaced with remimazolam 1 h before the end of surgery in Group PR; moreover, 0.5 mg of flumazenil was administered after the neuromuscular blockade reversal agent. The primary outcome was the duration of stay in the post-anesthesia care unit (PACU). The secondary outcomes included time to eye-opening, time to extubation, occurrence of PONV, and quality of recovery. Fifty-four patients were included in this study. The duration of stay in the PACU in Group PR was significantly shorter than that in Group P (mean difference, 8.7 min; confidence interval [95% CI], 3.3-14.2; P = 0.002). Group PR exhibited a shorter time to eye opening (mean difference, 5.4 min; 95% CI, 3.3-8.1; P < 0.001) and time to extubation (mean difference, 5.5 min; 95% CI, 3.6-7.9; P < 0.001) than Group P. Neither group required the administration of rescue analgesics, and the incidence of PONV was not reported. Transitioning from propofol to remimazolam 1 h before the end of surgery followed by flumazenil reversal reduced the duration of stay in the PACU and the time to eye opening and extubation without affecting the incidence of PONV and quality of recovery. Clinical Research Information Service (KCT0007794), Clinical trial first registration date: 12/10/2022.