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Randomized Controlled Trial
. 2025 Aug;39(4):600-606.
doi: 10.1007/s00540-025-03509-7. Epub 2025 Apr 30.

Comparative potentiating effects of remimazolam, propofol and sevoflurane on rocuronium-induced neuromuscular block: a randomized controlled trial

Tomoaki Itaya  1 , Shunichi Takagi  2 , Hanae Sato  2 , Osamu Kitajima  2 , Akira Doshu-Kajiura  2 , Miki Matsui  2 , Mai Yamamoto  2 , Masatoshi Yumoto  2 , Takahiro Suzuki  2
Affiliations
Randomized Controlled Trial

Comparative potentiating effects of remimazolam, propofol and sevoflurane on rocuronium-induced neuromuscular block: a randomized controlled trial

Tomoaki Itaya et al. J Anesth. 2025 Aug.

Abstract

Background: Remimazolam is a new type of ultra-short-acting benzodiazepine. The aim of this study was to investigate the effects of remimazolam, propofol and sevoflurane anesthesia on rocuronium-induced neuromuscular block.

Methods: Ninety-nine consenting patients were randomly assigned to a remimazolam group (R-group), sevoflurane group (S-group), or propofol group (P-group). Train-of-four (TOF) responses evoked on the abductor digiti minimi muscle to ulnar nerve stimulation following bolus administration of 0.9-mg/kg rocuronium were monitored with electromyography-based neuromuscular monitor. The primary outcomes were times from administration of rocuronium to first reappearance of post-tetanic count (PTC). Free plasma concentrations of rocuronium were concurrently measured at these events.

Results: Ninety patients were analyzed. No significant differences were seen in time to first PTC among the three groups. Mean (± standard deviation) and median (inter-quartile range) times for the reappearance of TOF counts 1 and 2 were significantly prolonged in S-group [50.7 ± 13.9 min, P = 0.043 and 61.6 (54.3-78.0) min, P = 0.020, respectively], when compared with P-group [42.6 ± 10.3 min and 52.9 (45.4-58.8) min, respectively]. However, no significant differences were seen between S-group and R-group. Median (inter-quartile range) free plasma concentration of rocuronium measured at first PTC was significantly lower in R-group [1255 (1126-1717) ng/mL] than in P-group [1717 (1592-1961) ng/mL, P = 0.031].

Conclusions: These results suggest that the potentiating effects of remimazolam on rocuronium-induced neuromuscular block are weaker than those of sevoflurane and similar to those of propofol.

Keywords: Benzodiazepine; Neuromuscular block; Neuromuscular monitoring; Remimazolam; Rocuronium.

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Conflict of interest statement

Declarations. Conflict of interest: Takagi S has received speaker fees from Nihon-Kohden, Inc, Japan. Itaya T has received speaker fees from Mundipharma Inc, Japan. Sato H, Kitajima O, Doshu-Kajiura A, Matsui M, Yumoto M, Yamamoto M and Suzuki T have no competing interests.

Comment in

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