Efficacy of remimazolam in preventing postoperative nausea and vomiting: a systematic review and meta-analysis

Abstract

This meta-analysis aimed to evaluate the efficacy of remimazolam, a newly introduced anesthetic, in preventing postoperative nausea and vomiting (PONV) compared to other anesthetics. A systematic search of studies published up to January 2024 in PubMed, Cochrane Library, and Embase was conducted to identify randomized controlled trials (RCTs) comparing remimazolam with other anesthetics in terms of PONV. Following data synthesis, outcomes were reported as the relative risk (RR) with 95% confidence interval (95% CI). Subgroup analyses were performed according to the type of comparator anesthetic. A total of 50 RCTs involving 9,193 participants were included. The results showed no significant difference in PONV incidence between remimazolam and other anesthetic agents (RR: 0.96, 95% CI: 0.80-1.13, P = 0.607). However, subgroup analysis demonstrated that a lower incidence of overall PONV was associated with remimazolam compared with inhalation anesthetics (n = 363; RR: 0.50; 95% CI: 0.34-0.73; P < 0.001). Conversely, a higher incidence of postoperative vomiting was associated with remimazolam compared with propofol (n = 3,860; RR: 1.41; 95% CI: 1.05-1.90; P = 0.024). Overall, there was no significant difference between remimazolam and other anesthetic agents in preventing PONV. However, subgroup analysis revealed that remimazolam was more effective than inhalation anesthetics in mitigating PONV, and it was inferior to propofol in preventing postoperative vomiting.

Keywords: Anesthetics; Nausea; Postoperative emesis; Postoperative nausea and vomiting; Remimazolam; Vomiting.

Fig. 1

PRISMA study selection flow diagram.

Fig. 2

Risk of bias percentage across domains.

Fig. 3

Forest plot for overall analysis. RR, relative risk; 95% CI, 95% confidence interval.

Fig. 4

Funnel plot. A: Overall analysis, B-E: Subgroup analysis—variations according to anesthetic comparators, F-G: Subgroup analysis—general anesthesia vs. procedural sedation, H-J: Subgroup analysis—variations according to surgical procedure types, K: Subgroup analysis—elderly patients only, L: Subgroup analysis—female patients only, M: Subgroup analysis—nausea only outcome, N: Subgroup analysis—vomiting only outcome, O: Subgroup analysis—continuous infusion, P: Subgroup analysis—intermittent bolus, Q: Sensitivity analysis—PONV as primary outcomes.

Fig. 5

Forest plot for subgroup analysis—variations according to anesthetic comparators. RR, relative risk; 95% CI, 95% confidence interval.

Fig. 6

Forest plot for subgroup analysis—nausea only outcome. RR, relative risk; 95% CI, 95% confidence interval.

Fig. 7

Forest plot for subgroup analysis—vomiting only outcome. RR, relative risk; 95% CI, 95% confidence interval.