Effects of Remimazolam-Propofol with Flumazenil Reversal on the Emergence Time and Hemodynamics of Patients Undergoing Laparoscopic Partial Hepatectomy: A Prospective Randomized Controlled Trial

Abstract

Background: Laparoscopic partial hepatectomy, characterized by significant surgical trauma, profound stress responses, prolonged duration, and high anesthetic requirements, may lead to delayed recovery or emergence agitation. Whether remimazolam and propofol combined with flumazenil reversal can accelerate the recovery and enhance hemodynamic stability remains controversial.

Methods: Fifty patients aged 18-70 years with American Society of Anesthesiologists (ASA) class I-III and Child-Pugh classification A or B undergoing elective laparoscopic partial hepatectomy were enrolled. Participants were randomly assigned to either the remimazolam combined with propofol group (RP group) or the propofol group (P group). Both groups received intravenous sufentanil and cisatracurium for induction, followed by either remimazolam-propofol with flumazenil reversal or propofol alone. Emergence parameters, including time to obey verbal commands, BIS over 80, and tracheal tube removal were recorded. The Sedation-Agitation Scale (SAS) and Visual Analog Scale (VAS) scores at predefined intervals, hemodynamics, and adverse events were recorded.

Results: The time to obey verbal commands (p<0.0001), BIS over 80 (p =0.0011), and tracheal tube removal (p=0.0002) were all significantly shorter in the RP group than in the P group. The SAS score after 30 min (p=0.0488) in the PACU was significantly higher, but the VAS score after 15 min (p=0.0086) and 30 min (p=0.0084) in the PACU, were significantly lower in the RP group than in the P group. MAP at T1 (p=0.0470) was significantly lower in the P group than in the RP group. In addition, the RP group demonstrated reduced post-induction hypotension, required no postoperative rescue analgesia, and reported no emergence agitation.

Conclusion: Compared to propofol alone, remimazolam-propofol with flumazenil reversal provides faster and more complete recovery, superior hemodynamic stability perioperatively, and reduced analgesic requirements in laparoscopic partial hepatectomy patients.

Keywords: emergence profile; flumazenil; hemodynamic stability; partial hepatectomy; propofol; remimazolam.

Figure 1

CONSORT flow diagram.

Figure 2

Hemodynamic parameters variations at different time points. Changes in MAP during perioperative period (A), changes in HR during perioperative period (B), changes in PI during perioperative period (C), changes in PPV during perioperative period (D). *p<0.05 versus Group RP. T0: before induction of anesthesia, T1: the time of induction of anesthesia, T2: the time of endotracheal intubation, T3: the time of skin incision, T4: the time of extubation; T5: the time of leaving the operating room.