The Effect of Remimazolam Compared to Sevoflurane on Postoperative Shivering in Patients Undergoing Laparoscopic Gynecologic Surgery under General Anesthesia: A Prospective Randomized Controlled Trial

Abstract

Background and objectives: Anesthesia maintenance agents affect the incidence of postoperative shivering (PS) after general anesthesia. This study compared the effects of remimazolam with sevoflurane on PS in patients undergoing laparoscopic gynecologic surgery under general anesthesia. Materials and methods: Seventy-four patients were allocated into one of two groups. In anesthesia maintenance, group S received sevoflurane and remifentanil, and group R received remimazolam and remifentanil. Results: The incidence and severity of postoperative shivering, mean arterial pressure (MAP), heart rate (HR), core body temperature, and the association of PS with hypothermia, MAP, or HR in the post-anesthesia care unit (PACU) were measured. Group R had significantly lower rates of perioperative hypothermia (58.8 vs. 27.8%, p = 0.009) and postoperative shivering (41.2 vs. 19.4%, p = 0.047). The severity of PS was also lower in group R than in group S (p = 0.034). Core body temperature was significantly higher in group R than in group S from 10 min after induction (p = 0.047) to the PACU (p = 0.009). MAP and HR were significantly higher in group R than in group S from 20 min after induction (p = 0.047) to the PACU (p = 0.009). In group S, the correlation between the severity of PS and the incidence of hypothermia (φc = 0.414, p = 0.121) was moderate but not significant. In group R, the correlation between PS severity and hypothermia (φc = 0.418, p = 0.043) was moderate and significant. Conclusions: Remimazolam showed better results than sevoflurane in anesthesia maintenance regarding hypothermia and PS.

Keywords: complication; hypothermia; remimazolam; shivering.

Figure 1

CONSORT flow diagram.

Figure 2

Core body temperature changes were measured in the nasopharynx (during surgery) and tympanic membrane (pre-induction and PACU). PACU, post-anesthesia care unit. Data are presented as estimated mean ± SE. * p < 0.05 vs. group S, ** p < 0.01 vs. group S, ^† p < 0.01 vs. pre-induction.

Figure 3

Mean arterial pressure and heart rate changes. PACU, post-anesthesia care unit. Data are presented as estimated mean ± SE. * p < 0.05 vs. group S, ** p < 0.01 vs. group S, ^† p < 0.01 vs. pre-induction.