Effect of remimazolam vs propofol on emergence from general anesthesia in patients undergoing cerebral endovascular procedures: A randomized controlled, non-inferiority trial

This study aimed to compare the time to emergence from general anesthesia with remimazolam versus propofol in patients undergoing cerebral endovascular procedures. A prospective, double-blind, randomized controlled, non-inferiority trial. An academic hospital. Adult patients scheduled for cerebral endovascular procedures. Patients were randomized at a 1:1 ratio to undergo surgery under general anesthesia with remimazolam (0.1 mg kg−1 for induction and 0.3–0.7 mg kg−1 h−1 for maintenance) or propofol (1–1.5 mg kg−1 for induction and 4–10 mg kg−1 h−1 for maintenance). The primary outcome was the time to emergence from anesthesia. The non-inferiority margin was −2.55 min in group difference. Major secondary outcomes included hypotension during induction, incidence of postoperative delirium and Modified Rankin Scale (mRs) at 30 days and 90 days after surgery. Of the 142 randomized patients, 129 completed the trial. In the modified intention-to-treat analysis, the mean time to emergence from anesthesia was 16.1 [10.4] min in the remimazolam group vs. 19.0 [11.2] min in the propofol group. The group difference was −2.9 min [95% CI -6.5, 0.7] (P = 0.003 for non-inferiority). The remimazolam group had lower rate of hypotension during induction (11.3% vs 25.4%, P = 0.03) and use of vasopressors during surgery (29.6% vs 62.0%, P < 0.001). The two groups did not differ in postoperative delirium and mRs at 30 and 90 days after surgery. In patients undergoing cerebral endovascular procedures, remimazolam did not increase the time from anesthesia vs propofol.