Remimazolam Compared to Propofol for Total Intravenous Anesthesia with Remifentanil on the Recovery of Psychomotor Function: A Randomized Controlled Trial.

Abstract

This study aimed to compare remimazolam to propofol in psychomotor recovery after total intravenous anesthesia (TIVA) using the Trieger dot test. Sixty-six patients who were scheduled to undergo endoscopic sinus surgery with American Society of Anesthesiologists (ASA) physical statusI or II were randomly allocated to the remimazolam (groupR) or propofol group (groupP). In groupR, all patients received flumazenil postoperatively. After discontinuation of anesthetic agents, the time to eye opening, response to verbal commands, extubation, and discharge from the operation room were measured. Psychomotor recovery was assessed using the Trieger dot test before induction and at 0, 30, 60, 90, 120, 150, and 180min after anesthesia. The time to eye opening, response to verbal commands, extubation, and discharge from the operation room were significantly longer in groupP compared to groupR (groupP: 9.8 ± 3.2min, 11.5 ± 3.4min, 12.7 ± 3.4min, 18.1 ± 4.2min; groupR: 6.5 ± 2min, 7.3 ± 2.6min, 8.4 ± 2.9min, 13.2 ± 3.2min; respectively, p < 0.05). In the Trieger dot test, the number of dots missed was significantly increased in groupR compared to groupP at 30, 60, 90, and 120min after discharge from the operation room (groupR: 20.5 ± 9.3, 16 ± 8.8, 14.9 ± 11.1, 14.3 ± 10.8; groupP: 14.6 ± 7.8, 10 ± 7.1, 8.7 ± 7.3, 7.3 ± 5.7; respectively, p < 0.05). The maximum distance of dots missed was significantly increased in groupR compared to groupP at 30min after discharge from the operation room (groupR: 3.9 ± 2.8; groupP: 2.7 ± 1.6; p < 0.05). Our results suggest that remimazolam with flumazenil leads to rapid recovery following anesthesia; however, it may cause delayed psychomotor decline. This trial is registered with the University Hospital Medical Information Network (registration number UMIN000044900).