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

Abstract

Abstract Background: Although the operation time of hysteroscopy is short, the incidence of postoperative nausea and vomiting (PONV) is high. Research shows that remimazolam besylate combined with remifentanil is safe and effective for anaesthesia during hysteroscopy. Alfentanil is a short-acting opioid drug with low respiratory inhibition, less cough and fast metabolism, thus making it suitable for daily surgical anaesthesia. Remimazolam is a new benzodiazepine drug that can be as effective in preventing PONV as midazolam. When remimazolam is compounded, it has the best compatibility with remifentanil and alfentanil to reduce PONV. The aim of this study was to compare the incidence of PONV between administration of remimazolam-remifentanil and remimazolam-alfentanil during hysteroscopy. 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, for 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. For 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 PONV. The secondary observation outcomes were hypoxemia during the operation and other adverse effects, such as bradycardia, hypotension and body movement. Results: A total of 204 patients were successfully included in this study. The incidence of PONV in Group RR (2/102, 2.0%) was significantly lower than that in Group RA (12/102, 11.8%) (p<0.05). There were no significant differences in the incidence of other adverse events, such as low SpO2, bradycardia, hypotension and body movement, between the RR and RA groups (p>0.05). Conclusions: Remimazolam-remifentanil causes less PONV than remimazolam-alfentanil during hysteroscopy. Trial registration Clinical trial registration number: ChiCTR2100044177. Full date of the frst registration: 12/03/2021.