• Ru-Ting Xue, Ran-Hong Sun, Min Wang, Hao Guo, and Jie Chang.
• Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China.
• Minerva Anestesiol. 2024 Nov 20.

IntroductionRemimazolam, a recently approved drug for surgical sedation and general anesthesia, has been compared with propofol in previous studies regarding its efficacy as a general anesthetic. However, the question of whether remimazolam demonstrates non-inferiority to propofol in postoperative subjective quality of recovery (QoR) among patients under general anesthesia has not been definitively answered.Evidence AcquisitionPubMed, Embase, and Cochrane Library databases were systematically searched for all published randomized controlled trials (RCTs) comparing the efficacy of remimazolam and propofol. The primary outcome assessed was the quality of recovery (QoR-15, QoR-40) on postoperative days (POD) 1-3. Secondary outcomes included the duration until consciousness recovery, extubation time, incidence of postoperative nausea and vomiting (PONV), and length of hospital stay.Evidence SynthesisThe analysis involved 10 RCTs with a total of 1077 patients. Remimazolam showed comparable QoR scores to propofol on POD1 (nine trials, standardized mean difference [SMD]: 0.14, 95% confidence interval [CI]: -0.15 to 0.44, P=0.34), POD 2 (two trials, SMD: 0.09, 95% CI: -0.18 to 0.36, P=0.5), and POD 3 (four trials, SMD: 0.17, 95% CI: -0.51 to 0.85, P=0.62). Subgroup and sensitivity analyses confirmed the robustness of these findings. Furthermore, no significant differences were observed in recovery time for consciousness, extubation duration, incidence of PONV, or length of hospital stay between the remimazolam and propofol groups.ConclusionsRemimazolam is similar to propofol in terms of postoperative subjective QoR for patients receiving general anesthesia.

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