| Title: |
Remimazolam Bolus Prevents Emergence Agitation After Rhinologic Surgery: A Randomized, Triple-Blind, Controlled Trial |
| Authors: |
Grgur Prižmić; Filip Periš; Marinela Jozeljić Pešić; Ana Maria Mitar; Ana Bego; Sanja Pavičić Perković; Sanda Stojanović Stipić |
| Source: |
Medical Sciences ; Volume 14 ; Issue 1 ; Pages: 129 |
| Publisher Information: |
Multidisciplinary Digital Publishing Institute |
| Publication Year: |
2026 |
| Collection: |
MDPI Open Access Publishing |
| Subject Terms: |
remimazolam; emergence agitation; rhinologic surgery; sevoflurane; randomized controlled trial; post-anesthesia care unit |
| Description: |
Background/Objectives: Emergence agitation (EA) is common after rhinologic surgery and may cause self-injury, bleeding, and prolonged post-anesthesia care unit (PACU) stay. Remimazolam is an ultra-short-acting benzodiazepine that may reduce EA without delaying recovery. The objective of this study was to evaluate the effect of a single dose of remimazolam administered at the end of surgery on the incidence of EA in adult patients undergoing nasal surgery. Methods: In this prospective, randomized, triple-blind, placebo-controlled trial, 62 adults undergoing elective rhinologic surgery under sevoflurane anesthesia received either remimazolam 0.1 mg/kg or saline immediately after sevoflurane discontinuation and before extubation. EA was assessed using the Richmond Agitation–Sedation Scale (RASS) at extubation and every 5 min for 30 min in the PACU. The primary outcome was presence of EA (RASS ≥ 2) at extubation. Secondary outcomes included Aldrete recovery scores, VAS, PONV incidence and safety outcomes. The study was registered at ClinicalTrials.gov (NCT06398275; 3 May 2024). Results: EA occurred in 12/32 patients (37.5%) in the control group and 0/30 (0%) in the remimazolam group (p < 0.001). Extubation time and operative durations were similar between groups. More patients in the remimazolam group achieved an Aldrete score ≥ 9 at extubation (76.7% vs. 50.0%, p=0.030). Severe agitation (RASS ≥ 3) requiring rescue sedation occurred in 6/32 control-group patients and in 0/30 patients in the remimazolam group (p=0.025). Pain scores were low (no VAS > 2). PONV occurred in one patient per group. Clinically relevant postoperative nasal bleeding requiring intervention occurred in 2/32 control-group patients and in 0/30 remimazolam-group patients. No laryngospasm or respiratory complications within 24 h were observed. Conclusions: A single remimazolam bolus given at the end of surgery prevented clinically relevant EA after rhinologic surgery without delaying early recovery. |
| Document Type: |
text |
| File Description: |
application/pdf |
| Language: |
English |
| Relation: |
https://dx.doi.org/10.3390/medsci14010129 |
| DOI: |
10.3390/medsci14010129 |
| Availability: |
https://doi.org/10.3390/medsci14010129 |
| Rights: |
https://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.BE5182A |
| Database: |
BASE |