• Junbao Zhang, Jiuxiang Zhang, Yunying Wang, Xiaoguang Bai, Qingdong Guo, Wei Liu, Hui Li, Fei Zhu, Xiaohui Wang, Xiaofan Jiang, Hailong Dong, Haopeng Zhang, and Zhihong Lu.
• Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of the Air Force Medical University, Xi'an, Shaanxi 710032, China.
• J Clin Anesth. 2024 May 1; 93: 111356111356.

Study ObjectiveThis study aimed to compare the time to emergence from general anesthesia with remimazolam versus propofol in patients undergoing cerebral endovascular procedures.DesignA prospective, double-blind, randomized controlled, non-inferiority trial.SettingAn academic hospital.PatientsAdult patients scheduled for cerebral endovascular procedures.InterventionsPatients 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).MeasurementsThe 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.Main ResultsOf 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.ConclusionsIn patients undergoing cerebral endovascular procedures, remimazolam did not increase the time from anesthesia vs propofol.Copyright © 2023 Elsevier Inc. All rights reserved.

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