Effect of Remimazolam on Postoperative Cough in Patients Undergoing Thyroid Surgery: A Randomized Double-Blind Controlled Clinical Trial

Purpose: This study aimed to evaluate the inhibitory effect of remimazolam on coughing during emergence from general anesthesia in patients undergoing thyroid surgery. Methods: Sixty-eight patients were randomly assigned to two groups (n = 34 each). After anesthesia induction, the remimazolam group (R group) received a continuous infusion of 0.4 mg/kg/h remimazolam, while the control group (C group) received an equal volume of saline until the end of surgery. Both groups were maintained with remifentanil and sevoflurane. The incidence and severity of coughing during emergence, awakening time, extubation time, and sedation scores were recorded. Heart rate and mean arterial pressure were measured at five time points: admission (T0), 2 min before intubation (T1), 2 min after intubation (T2), end of surgery (T3), and extubation (T4). Adverse events were also documented. Results: The incidence of coughing was significantly lower in the R group (38.24%) than in the C group (76.47%) (risk difference RD, -38.2%; 95% CI, -59.9% to -16.6%; relative risk RR, 0.50; 95% CI, 0.30-0.82; P < 0.005). Moderate to severe coughing occurred less frequently in the R group (14.71% vs 35.29%, P = 0.029), and overall coughing severity was lower (P < 0.001). Awakening and extubation times were longer in the R group (P < 0.0001), and sedation scores were higher at response and extubation (P < 0.0001, P = 0.002). Heart rate and mean arterial pressure decreased in both groups without significant intergroup differences. Conclusion: Remimazolam significantly reduces the incidence of coughing during emergence from general anesthesia in thyroid surgery.