Quality of Postoperative Recovery in Total Intravenous Anesthesia between Remimazolam and Propofol for Intraoperative Neurophysiological Monitoring: A Prospective Double-Blind Randomized Controlled Trial

Abstract

This study compared the overall postoperative recovery of patients who underwent total intravenous anesthesia with remimazolam or propofol, using the Quality of Recovery-15 questionnaire (QoR-15). Seventy-two patients who underwent spine surgery with intraoperative neurophysiological monitoring (IONM) were randomly categorized into the remimazolam group (group R) or propofol group (group P). On the first postoperative day, the QoR-15 scores for groups P and R were 114 and 112, respectively, indicating no significant difference (p = 0.691). Similarly, group-time interaction effects on QoR-15 scores were not significantly different. In the post-anesthesia care unit, the pain intensity at rest was notably higher in group P than in group R (3.0 [0.0] vs. 2.8 [0.5], respectively, p = 0.009). Although the intraoperative consumption of remifentanil was higher in group R (1452.4 µg vs. 2066.8 µg, respectively, p < 0.001), the intraoperative use of vasopressors was lower in group R (1705.6 µg vs. 286.1 µg, respectively, p < 0.001) compared to group P. Group R exhibited significantly lower variability in mean blood pressure over time compared to group P. Remimazolam was viewed as a promising intravenous agent for general anesthesia, showing potential to replace propofol in spine surgery with IONM, considering both recovery quality and intraoperative hemodynamic stability.

Keywords: intraoperative neurophysiological monitoring; propofol; quality of recovery; remimazolam; total intravenous anesthesia.

Figure 1

CONSORT flow diagram.

Figure 2

Total QoR-15 scores. Boxplots represent medians and 25% and 75% interquartile ranges. Dotted plots show the QoR-15 score distribution. Abbreviations: POD, postoperative day; preop, preoperative; QoR-15, Quality of Recovery-15 questionnaire.

Figure 3

Perioperative data: (A) SBP, (B) DBP, (C) MBP, (D) HR, (E) PSI, and (F) SpO₂. Values are presented as estimated mean and standard error. * represents variables with significant interactions between group and time after analysis using linear mixed model. Abbreviations: bpm, beats per minute; DBP, diastolic blood pressure; HR, heart rate; MBP, mean blood pressure; OR, operating room; PACU, post-anesthetic care unit; PSI, patient state index; SBP, systolic blood pressure; SpO₂, peripheral oxygen saturation.