Anesth Pain Med.  2024 Jan;19(1):44-53. 10.17085/apm.23102.

Effects of remimazolam combined with remifentanil on quality of recovery after ambulatory hysteroscopic surgery: a prospective, observational study

• Park I
• Kim J
• Chung SH
• Na HS
• Do SH

• KMID: 2552856
• DOI: http://doi.org/10.17085/apm.23102

Abstract

Background
Remimazolam, a new benzodiazepine, is known for its quick onset of effects and recovery time. Recently, it has been licensed for general anesthesia and sedation in Korea and its use is increasing in other countries. However, less is known about its effect on postoperative recovery. We used a patient-reported outcome questionnaire to examine the effect of remimazolam on postoperative recovery.
Methods
Patients who underwent hysteroscopy on day surgery basis were administered an induction dose of remimazolam 6 mg/kg/h followed by a maintenance dose of 1–2 mg/kg/h. After surgery, the translated Korean version of 15-item Quality of Recovery scale (QoR-15K) including post-discharge nausea and vomiting (PDNV) and/or pain, was surveyed 24 h after surgery to evaluate patient recovery.
Results
Total of 38 patients were enrolled in this prospective, observational study. All patients successfully completed QoR-15K. Only one patient scored low for moderate pain and PDNV. On average, patients scored 9 and above for all QoR-15K items except for moderate pain (8.66 ± 1.68). When QoR-15K items were grouped into dimensions, all dimensions scored an average of 9 or higher on a 10-point scale. In addition, 19 out of 38 patients gave score range of 148 to 150 out of possible 150.
Conclusions
Psychometric evaluation based on postoperative QoR-15K among patients receiving remimazolam shows satisfactory patient recovery profiles without significant pain or PDNV. Considering its effectiveness and safety, remimazolam could be one of useful agents for general anesthesia of day surgery in terms of postoperative recovery.

Keyword

Ambulatory surgical procedure; Anesthesia, general; Anesthesia recovery period; Patient outcome assessment; Remimazolam; Remifentanil

Figure

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  Fig. 1. Study flow diagram.

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  Fig. 2. Percentage of patients who scored in range of 1–3, 4–7, and 8–10 for each item listed in the translated Korean version of the 15-item Quality of Recovery questionnaire.

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  Fig. 3. Boxplots of 10-point scale score of the 15-item Quality of Recovery (QoR-15K) dimension for each QoR-15K dimension.

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  Fig. 4. Box-and-whisker plot and histogram of the 15-item Quality of Recovery (QoR-15K) total score. Right and left whiskers denote maximum and minimum values excluding outliers, respectively.

Reference

1. Antonik LJ, Goldwater DR, Kilpatrick GJ, Tilbrook GS, Borkett KM. A placebo- and midazolam-controlled phase I single ascending-dose study evaluating the safety, pharmacokinetics, and pharmacodynamics of remimazolam (CNS 7056): Part I. Safety, efficacy, and basic pharmacokinetics. Anesth Analg. 2012; 115:274–83.

2. Morimoto Y. Efficacy and safety profile of remimazolam for sedation in adults undergoing short surgical procedures. Ther Clin Risk Manag. 2022; 18:95–100.

3. Kilpatrick GJ, McIntyre MS, Cox RF, Stafford JA, Pacofsky GJ, Lovell GG, et al. CNS 7056: a novel ultra-short-acting Benzodiazepine. Anesthesiology. 2007; 107:60–6.

4. Olkkola KT, Ahonen J. Midazolam and other benzodiazepines. Modern anesthetics. 2008; 335–60.

5. Sipe BW, Rex DK, Latinovich D, Overley C, Kinser K, Bratcher L, et al. Propofol versus midazolam/meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists. Gastrointest Endosc. 2002; 55:815–25.

6. Ulmer BJ, Hansen JJ, Overley CA, Symms MR, Chadalawada V, Liangpunsakul S, et al. Propofol versus midazolam/fentanyl for outpatient colonoscopy: administration by nurses supervised by endoscopists. Clin Gastroenterol Hepatol. 2003; 1:425–32.

7. Tang F, Yi JM, Gong HY, Lu ZY, Chen J, Fang B, et al. Remimazolam benzenesulfonate anesthesia effectiveness in cardiac surgery patients under general anesthesia. World J Clin Cases. 2021; 9:10595–603.

8. Dou D, Feng Y, Jiang L. Efficiency and safety of remimazolam and midazolam in digestive endoscopic sedation: Systematic review and meta-analysis. Dig Endosc. 2022; 34:653.

9. Sato T, Nishiwaki K. Comparison of remimazolam and propofol in anesthetic management for awake craniotomy: a retrospective study. J Anesth. 2022; 36:152–5.

10. Zhang S, Wang J, Ran R, Peng Y, Xiao Y. Efficacy and safety of remimazolam tosylate in hysteroscopy: A randomized, single-blind, parallel controlled trial. J Clin Pharm Ther. 2022; 47:55–60.

11. Bowyer A, Jakobsson J, Ljungqvist O, Royse C. A review of the scope and measurement of postoperative quality of recovery. Anaesthesia. 2014; 69:1266–78.

12. Stark PA, Myles PS, Burke JA. Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15. Anesthesiology. 2013; 118:1332–40.

13. Myles PS, Weitkamp B, Jones K, Melick J, Hensen S. Validity and reliability of a postoperative quality of recovery score: the QoR-40. Br J Anaesth. 2000; 84:11–5.

14. Yoon S, Joo H, Oh YM, Lee J, Bahk JH, Lee HJ. Validation and clinical utility of the Korean version of the Quality of Recovery-15 with enhanced recovery after surgery: a prospective observational cohort study. Br J Anaesth. 2020; 125:614–21.

15. Shi F, Chen Y, Li H, Zhang Y, Zhao T. Efficacy and Safety of remimazolam yosilate versus propofol for general anesthesia in cirrhotic patients undergoing eEndoscopic variceal ligation. Int J Gen Med. 2022; 15:583–91.

16. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014; 12:1495–9.

17. De Vlieger JCN, Luiting WH, Lockyer J, Meyer P, Fleer J, Sanderman R, et al. Validation of the Dutch translation of the quality of recovery-15 scale. BMC Anesthesiol. 2022; 22:243.

18. McDowell I. Measuring Health; A Guide to Rating Scales and Questionnaires. The theoretical and technical foundations of health measurement. Oxford: Oxford University Press;1996. p. 10–46.

19. Vasileiou I, Xanthos T, Koudouna E, Perrea D, Klonaris C, Katsargyris A, et al. Propofol: a review of its non-anaesthetic effects. Eur J Pharmacol. 2009; 605:1–8.

20. Zhang X, Li S, Liu J. Efficacy and safety of remimazolam besylate versus propofol during hysteroscopy: single-centre randomized controlled trial. BMC Anesthesiol. 2021; 21:156.

21. Lee WK, Kim MS, Kang SW, Kim S, Lee JR. Type of anaesthesia and patient quality of recovery: a randomized trial comparing propofol-remifentanil total i.v. anaesthesia with desflurane anaesthesia. Br J Anaesth. 2015; 114:663–8.