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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2023

Open Access 01-12-2023 | Postoperative Nausea and Vomiting | Research

Remimazolam-remifentanil causes less postoperative nausea and vomiting than remimazolam-alfentanil during hysteroscopy: a single-centre randomized controlled trial

Authors: Xiaoqiang Zhang, Shuang Li, Jing Liu

Published in: BMC Anesthesiology | Issue 1/2023

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Abstract

Background

Although the operation time of hysteroscopy is short, the incidence of postoperative nausea and vomiting is high. The aim of this study was to compare the incidence of postoperative nausea and vomiting in hysteroscopy when remimazolam is combined with remifentanil or alfentanil.

Methods

We conducted a randomized, controlled, double-blind trial. Patients undergoing hysteroscopy were recruited and randomly assigned to either the remimazolam-remifentanil (Group RR) or the remimazolam-alfentanil group (Group RA). All patients in the two groups were started with an induction dose of remimazolam besylate 0.2 mg/kg and then maintained with a dosage of 1.0 mg/kg/h. After induction with remimazolam besylate, in Group RR, remifentanil was infused using a target-controlled infusion system with a target concentration of 1.5 ng/ml and titrated throughout the procedure. In Group RA, infusion of alfentanil was started with an initial bolus dose of 20 µg/kg over 30 s and then maintained at an initial rate of 0.16 µg/kg/min. The primary observation outcome was the incidence rate of postoperative nausea and vomiting. The secondary observation outcomes were the time to awakening, the length of stay in the PACU, the total remimazolam dose and adverse effects, such as low SpO2, bradycardia, hypotension and body movement.

Results

A total of 204 patients were successfully included in this study. The incidence of postoperative nausea and vomiting in Group RR (2/102, 2.0%) was significantly lower than that in Group RA (12/102, 11.8%) (p < 0.05). There was no significant difference in the incidence of adverse events, such as low SpO2, bradycardia, hypotension and body movement, between Groups RR and RA (p > 0.05).

Conclusions

Remimazolam-remifentanil causes less postoperative nausea and vomiting than remimazolam-alfentanil in hysteroscopy.

Trial registration

Clinical trial registration number: ChiCTR2100044177. Full date of the first registration: 12/03/2021.
Appendix
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Literature
1.
Gupta AnilWuCL, Elkassabany Nabil, et al. Does the routine prophylactic use of antiemetics affect the incidence of postdischarge nausea and vomiting following ambulatory surgery?: a systematic review of randomized controlled trials. [J] Anesthesiology. 2003;99:488–95.CrossRef
2.
Duleba Antoni I-KN, Mrozikiewicz Aleksandra J, et al. Relationship of Postoperative Pain and PONV after minimally invasive surgery with the serotonin concentrations and receptors’ gene Polymorphisms[. J] J Pers Med. 2021;11:undefined.
3.
Apfel CC, Läärä E, Koivuranta M, et al. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers.[J]. Anesthesiology. 1999;91(3):693–700.CrossRefPubMed
4.
Moharram Ehab E, El Attar Ahmed M, Kamel Moustafa. A,the impact of anesthesia on hemodynamic and volume changes in operative hysteroscopy: a bioimpedance randomized study[. J] J Clin Anesth. 2017;38:59–67.CrossRefPubMed
5.
Park Seongjoo,Choi Soo-Lyoen,Nahm Francis Sahngun. Dexmedetomidine-remifentanil vs propofol-remifentanil for monitored anesthesia care during hysteroscopy: Randomized, single-blind. controlled trial [J] Medicine (Baltimore). 2020;99:e22712.CrossRefPubMed
6.
Mandel Jeff E. Considerations for the use of short-acting opioids in general anesthesia[. J] J Clin Anesth. 2014;26:1–7.CrossRef
7.
Yi Fuxia,Xiao Hongyi,Zhu Teng. Prevention of postoperative nausea and vomiting after gynaecological day surgery under remimazolam general anesthesia: a randomized double-blind controlled study[. J] BMC Anesthesiol. 2022;22:292.CrossRef
8.
Dogru K, Madenoglu H,Yildiz K, et al. Sedation for outpatient endometrial biopsy: comparison of remifentanil-propofol and alfentanil-propofol[. J] J Int Med Res. 2003;31:31–5.CrossRefPubMed
9.
Sneyd JR. Rigby-Jones Ann E,Remimazolam for anaesthesia or sedation. [J]. Curr Opin Anaesthesiol. 2020;33:506–11.CrossRefPubMed
10.
Zhang X, Li S, Liu J. Efficacy and safety of remimazolam besylate versus propofol during hysteroscopy: single-centre randomized controlled trial[J]. BMC Anesthesiol, 2021, 21(1).
11.
Chernik DA, Gillings D, Laine H, et al. Validity and reliability of the Observer’s Assessment of Alertness/Sedation scale: study with intravenous midazolam. J Clin Psychopharmacol. 1990;10:244–51.PubMed
12.
Chisholm Christopher J, Dmitry, et al. Comparison of electrophysiologic monitors with clinical assessment of level of sedation.[J]. Mayo Clin Proc. 2006;81:46–52.CrossRefPubMed
13.
Lee KH, Kim YH, Sung YJ, et al. The patient State Index is well balanced for propofol sedation[J]. Hippokratia. 2015;19(3):235–8.PubMedPubMedCentral
14.
Sheng XY, Liang Y, Yang XY, Li LE, Ye X, Zhao X, et al. Safety, pharmacokinetic and pharmacodynamic properties of single ascending dose and continuous infusion of remimazolam besylate in healthy chinese volunteers. Eur J Clin Pharmacol. 2020;76:383–91.CrossRefPubMed
15.
16.
Minto CF, Schnider TW, Egan TD, Youngs E, Lemmens HJ, Gambus PL, et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I. Model development. Anesthesiology. 1997;86:10–23.CrossRefPubMed
17.
Hese LV, Theys T, Absalom AR, et al. Comparison of predicted and real propofol and remifentanil concentrations in plasma and brain tissue during target controlled infusion: a prospective observational study[J]. Anaesthesia; 2020.
18.
Crozier TA, Kietzmann D, D?Bereiner. B. Mood change after anaesthesia with remifentanil or alfentanil[J]. European Journal of Anaesthesiology, 2004, 21(1):20.
19.
Caputo Thomas D, Ramsay Michael AE, Rossmann Jeffrey A, et al. Evaluation of the SEDline to improve the safety and efficiency of conscious sedation.[J].Proc. (Bayl Univ Med Cent). 2011;24:200–4.
20.
Ye T, Yi Y. Sample size calculations in clinical research, third edition, by Shein-Chung Chow, Jun Shao, Hansheng Wang, and Yuliya Lokhnygina. Stat Theory Relat Fields. 2017;1:265–6.CrossRef
21.
Schüttler J, Eisenried A, Lerch M, Fechner J, Jeleazcov C, Ihmsen H. Pharmacokinetics and pharmacodynamics of remimazolam (CNS 7056) after continuous infusion in healthy male volunteers: part I. pharmacokinetics and clinical pharmacodynamics. Anesthesiology. 2020;132:636–51.CrossRefPubMed
22.
Hari Yuki,Satomi Shiho,Murakami Chiaki. Remimazolam decreased the incidence of early postoperative nausea and vomiting compared to desflurane after laparoscopic gynecological surgery[. J] J Anesth. 2022;36:265–9.CrossRefPubMed
23.
Ahn Eun Jin,Kang Hyun,Choi Geun Joo. The effectiveness of Midazolam for preventing postoperative nausea and vomiting: a systematic review and Meta-analysis. [J] Anesth Analg. 2016;122:664–76.CrossRef
24.
Zhou Lijin,Yang Honghao,Hai Yong et al. Perioperative Low-Dose Ketamine for Postoperative Pain Management in Spine Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.[J].Pain Res Manag et al. 2022, 2022: 1507097.
25.
Beloeil Helene,Garot Matthias,Lebuffe Gilles. Balanced opioid-free anesthesia with Dexmedetomidine versus Balanced Anesthesia with Remifentanil for Major or. Intermediate Noncardiac Surgery [J] Anesthesiology. 2021;134:541–51.PubMed
26.
Ozkose Z, Cok OY, Tuncer B et al. Comparison of hemodynamics, recovery profile, and early postoperative pain control and costs of remifentanil versus alfentanil-based total intravenous anesthesia (TIVA)[J]. 2002, 14(3):0–168.
27.
Langevin S, Lessard M R,Trépanier CA et al. Alfentanil causes less postoperative nausea and vomiting than equipotent doses of fentanyl or sufentanil in outpatients.[J].Anesthesiology, 1999, 91: 1666–73.
28.
Egan, Talmage D et al. Remifentanil Versus Alfentanil[J]. Anesthesiology, 1996.
29.
Wilhelm Wolfram,Kreuer Sascha,The place for short-acting opioids: special emphasis on remifentanil.[J].Crit Care, 2008, null: S5.
30.
Schulz Hapfelmeier Alexander HF, et al. A period of immobility after remifentanil administration protects from nausea: an experimental randomized cross-over study. [J] BMC Anesthesiol. 2016;16:90.CrossRefPubMedCentral
Metadata
Title
Remimazolam-remifentanil causes less postoperative nausea and vomiting than remimazolam-alfentanil during hysteroscopy: a single-centre randomized controlled trial
Authors
Xiaoqiang Zhang
Shuang Li
Jing Liu
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2023
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-023-02164-3

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