- Design
- Single-centre, prospective randomised controlled trial
- Population
- 113 patients undergoing laparoscopic gynaecological oncology surgery
- Primary outcome
- Postoperative nausea and vomiting within 24 hours
- Effect
- 21.1% vs 44.6% (p=0.013); absolute reduction about 24 percentage points
Postoperative nausea and vomiting is common after laparoscopic gynaecological surgery, especially in women with several risk factors given a volatile anaesthetic. This single-centre randomised trial compared remimazolam-based with sevoflurane-based maintenance in 113 such patients.
Nausea and vomiting within 24 hours fell from 44.6% with sevoflurane to 21.1% with remimazolam, an absolute reduction of about 24 percentage points. The authors note the reduction, while significant, was a little smaller than the effect size they had powered for, and higher intra-operative blood pressure with remimazolam did not explain the difference.
The practical reading is that switching from a volatile to remimazolam maintenance is a reasonable lever for nausea in high-risk patients, alongside standard antiemetic prophylaxis rather than instead of it. This is one small, single-centre trial, so weigh it as supporting evidence rather than a definitive comparison.
- Nausea and vomiting within 24 hours was 21.1% with remimazolam vs 44.6% with sevoflurane (p=0.013).
- The absolute reduction was about 24 percentage points, slightly smaller than the powered effect size.
- Higher intra-operative blood pressure with remimazolam did not explain the nausea difference.
- Consider remimazolam maintenance as one lever for nausea in high-risk patients, alongside standard antiemetic prophylaxis.
Why it matters
It gives a concrete anaesthetic choice — not just antiemetics — to lower nausea in the patients most prone to it.
Don't overread it
Single-centre and modest in size; it does not establish remimazolam as superior across populations or procedures.
The statistics, in plain English
A fall from 44.6% to 21.1% is a large absolute drop, but with 113 patients the confidence around it is wide, which is why the authors flag that the observed effect was smaller than planned. It supports, rather than settles, the comparison.
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