Comparison of Remimazolam-Flumazenil versus Propofol for Rigid Bronchoscopy: A Prospective Randomized Controlled Trial

Abstract

Background: Remimazolam is a novel ultrashort-acting intravenous benzodiazepine sedative−hypnotic that significantly reduces the times to sedation onset and recovery. This trial was conducted to confirm the recovery time from anesthesia of remimazolam-flumazenil versus propofol in patients undergoing endotracheal surgery under rigid bronchoscopy. Methods: Patients undergoing endotracheal tumor resection or stent implantation were randomly allocated into a remimazolam group (Group R) or a propofol group (Group P). The primary outcome was the recovery time from general anesthesia. The secondary outcomes were the time to loss of consciousness (LoC), hemodynamic fluctuations, and adverse events. Results: A total of 34 patients were screened, and 30 patients were enrolled in the study. The recovery time was significantly shorter for Group R (140 ± 52 s) than for Group P (374 ± 195 s) (p < 0.001). The times to LoC were 76 ± 40 s in Group R and 75 ± 25 s in Group P and were not significantly different. There were also no significant differences in hemodynamic fluctuations or adverse events between the two groups. Conclusions: The recovery time from general anesthesia in rigid bronchoscopy patients was shorter using remimazolam-flumazenil than with propofol, with no dramatic hemodynamic fluctuations and adverse events or differences between the agents. Remimazolam-flumazenil allows for faster recovery from anesthesia than propofol.

Keywords: flumazenil; hemodynamic fluctuations; loss of consciousness; propofol; recovery time from anesthesia; remimazolam; rigid bronchoscopy.

Figure 1

Process of endobronchial tumor resection under rigid bronchoscopy: (a) before bronchial tumor resection; (b) during bronchial tumor resection; (c) after bronchial tumor resection.

Figure 2

Enrollment diagram.

Figure 3

The LoC values and recovery times of the two groups. *** p < 0.001; ns: not significantly different; LoC: loss of consciousness.

Figure 4

Hemodynamic fluctuations: (a) MAP mean values and SD, as well as HR mean values and SD; (b) HR mean values at different time points; (c) MAP mean values at different time points. MAP: mean arterial pressure; HR: heart rate; SD: standard deviation; bpm: beats per minute; T0: baseline; T1: intubation; T2: 5 min after intubation; T3: 10 min after intubation; T4: 15 min after intubation; T5: 20 min after intubation; T6: extubation.