Comparative study of recovery characteristics between remimazolam anesthesia with flumazenil and desflurane anesthesia for closed reduction of nasal bone fracture: a randomized controlled trial

Background: In otorhinolaryngologic surgery, immediate and smooth emergence from general anesthesia is important for patient safety. Therefore, we compared the recovery profile of desflurane to that of remimazolam with flumazenil reversal in patients undergoing nasal bone fracture reduction surgery. Methods: In this randomized controlled trial, patients were randomly assigned to the Desflurane (n=29) or Remimazolam group (n=29), which received desflurane or remimazolam, respectively, for anesthesia maintenance. Flumazenil (0.2 mg) was administered at the end of surgery in the Remimazolam group. The primary outcome was the time from anesthetic agent discontinuation to the point at which patients could follow a verbal command (emergence time). Secondary outcomes included time to first eye opening, time to extubation, incidence of emergence agitation, cough severity, and adverse events in the postanesthesia care unit. Results: The emergence time was significantly shorter in the Remimazolam group than in the Desflurane group (317±111 s [mean±SD] vs. 512±138 s; mean difference: 195 s; 95% CI [129-261]; P<0.001). The times to first eye opening (256±106 s vs. 452±124 s; P<0.001) and extubation (343±104 s vs. 500±130 s; P<0.001) were shorter, and emergence agitation was less frequent (6/29 [20.7%] vs. 14/29 [48.3%]; P=0.027) in the Remimazolam group than in the Desflurane group. The Remimazolam group experienced less severe coughing than the Desflurane group did (P=0.003). There were no significant differences in adverse events between the groups. Conclusions: Compared with desflurane, remimazolam with flumazenil hastens recovery and reduces emergence agitation and cough severity in patients undergoing nasal bone fracture reduction surgery.