• Jaemoon Lee, Dong Hyouk Kim, JuJae-WooJW, Karam Nam, Youn Joung Cho, Yunseok Jeon, and Seohee Lee.
• From the Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea (JL, DHK, JWJ, KN, YJC, YJ, SL) and Department of Anaesthesiology and Pain Medicine, Konkuk University Hospital, Konkuk University College of Medicine, Seoul, Republic of Korea (JL).
• Eur J Anaesthesiol. 2024 Mar 1; 41 (3): 199207199-207.

BackgroundRemimazolam, a short acting benzodiazepine, is being used for general anaesthesia. The results of studies comparing recovery after propofol with that of remimazolam are inconsistent. Given that flumazenil reverses the sedative effects of remimazolam, we hypothesised that it would speed up recovery from remimazolam general anaesthesia.ObjectivesThe aim of this trial was to compare the speed of recovery from general anaesthesia between propofol and remimazolam reversed with flumazenil in patients undergoing minimally invasive breast surgery.DesignRandomised, single-centre, double-blind controlled trial.SettingA tertiary teaching hospital in South Korea from August 2022 to December 2022.PatientsAdult patients (≥19 years of age) about to undergo general anaesthesia for scheduled breast cancer surgery.InterventionsPatients were randomly allocated to either the propofol or the remimazolam/flumazenil group. The emergence process was monitored by only one anaesthesiologist.Main Outcome MeasuresThe primary outcome was the time to eye opening to command during recovery from the general anaesthesia. Time to removal of the supraglottic airway (SGA) time to discharge, and the Riker sedation agitation scale (SAS) score (1 to 4) during emergence were compared as secondary outcomes.ResultsThe remimazolam group had a significantly shorter mean time to eye opening than the propofol group [127 ± 51 vs. 314 ± 140 s; mean difference 187 s (95% confidence interval (CI), 133 to 241 s; P  < 0.001]. The remimazolam group also had shorter times to SGA removal [169 ± 51 vs. 366 ± 149 s; mean difference 198 s (95% CI, 140 to 255 s); P  < 0.001] and time to discharge from the operating room [243 ± 55 vs. 449 ± 159 s; mean difference 206 s (95% CI, 145 to 267 s); P  < 0.001]. The SAS scores during emergence also differed significantly, with 1 patient in the propofol group and 25 in the remimazolam group attaining scores of 4 ( P  < 0.001).ConclusionAdministration of remimazolam with flumazenil may be a promising option for patients undergoing breast cancer surgery, providing faster recovery and better SAS scores than propofol during emergence from general anaesthesia.Trial RegistrationClinicalTrials.gov (NCT05435911).Copyright © 2024 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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