- Design
- Prospective, single-blind randomised trial
- Population
- 86 patients having short-duration gynaecological surgery
- Primary outcome
- Recovery profile: immediate, intermediate and long-term phases
- Effect
- Eye-opening and extubation shorter with remimazolam (P < 0.001); QoR-15K not significantly different
In this single-blind trial, 86 patients having short gynaecological surgery were randomised to remimazolam or propofol, both with remifentanil. At the end of surgery everyone received sugammadex 2 mg/kg, and the remimazolam group also received flumazenil 200 µg.
Eye-opening and extubation times were significantly shorter with remimazolam (P < 0.001). Time in the post-anaesthesia care unit was longer, which the authors attribute to institutional safety protocols after flumazenil (P < 0.001). Quality of Recovery-15K scores and later recovery measures at 4 hours and 1 day did not differ significantly, though scores were numerically higher with remimazolam.
The faster wake-up is a minutes-scale gain, in a single-blind trial of low-risk patients. It does not show an advantage in the outcomes that patients feel, and the reversal step adds a drug.
- Remimazolam with flumazenil shortened emergence times compared with propofol.
- Later recovery quality (QoR-15K at 4 hours and day 1) did not differ significantly.
- Watch for re-sedation after flumazenil, which is why some units extend recovery observation.
- Choose the agent on the clinical picture, not on emergence time alone.
Why it matters
Faster emergence is often assumed to equal better recovery, and this trial separates the two.
Don't overread it
Eighty-six low-risk patients in one single-blind trial cannot establish benefit or safety for remimazolam in other settings.
The statistics, in plain English
A very small P value for emergence time tells you the difference is real, not that it matters; the trial reports no difference in the broader recovery score, whose P value was above 0.05 despite higher numbers with remimazolam.
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