Comparison of the recovery profiles of remimazolam-remifentanil and propofol-remifentanil in older patients undergoing laparoscopic abdominal surgeries

Background: We compared the quality of recovery (QoR) between total intravenous anesthesia using remimazolam and propofol in older patients undergoing laparoscopic abdominal surgeries.Methods: A total of 120 patients (aged ≥ 60 years) undergoing laparoscopic gastric or colorectal surgery were randomized to the remimazolam or propofol group. Continuous remimazolam/propofol infusion and target-controlled remifentanil infusion were performed. Recovery was evaluated using the Korean version of the Quality of Recovery-15 (QoR-15K) questionnaire. The primary outcome was the QoR-15K score on postoperative day (POD) 3. Secondary outcomes included the QoR-15K score on POD 1; perioperative mean arterial pressure and heart rate; times to eye opening, extubation, and full recovery; post-anesthetic care unit (PACU) adverse events; postoperative delirium; and duration of hospitalization.Results: The total QoR-15K scores over time did not make differences significantly between the groups. Total QoR-15K scores on POD 3 (112.0 96.0, 119.0 vs. 104.0 84.8, 120.5, P = 0.481) and POD 1 (80.0 62.0, 97.0 vs. 78.0 60.8, 95.3, P = 0.635) were comparable between the groups. The MAP and HR were significantly higher in the remimazolam group. The times to extubation (12.0 11.0, 15.0 vs. 10.5 9.0, 12.3 min, P = 0.003) and full recovery (13.0 9.0, 16.0 vs. 11.5 8.0, 14.0 min, P = 0.045) were notably longer in the remimazolam group. The incidence of adverse events in the PACU and postoperative delirium, and duration of hospitalization were comparable between the groups.Conclusions: Remimazolam yielded a similar QoR as propofol in older patients undergoing laparoscopic abdominal surgeries.