Korean journal of anesthesiologyApr 18, 2024

Rates of nausea and vomiting after general anesthesia with remimazolam compared to sevoflurane

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Updated Apr 4, 2026

Abstract

The remimazolam group had a 5% incidence of postoperative nausea and vomiting compared to 45% in the sevoflurane group.

Remimazolam is associated with a significantly lower rate of postoperative nausea and vomiting (PONV) for 24 hours after surgery compared to sevoflurane.
The use of dexamethasone, a rescue antiemetic, was notably lower in the remimazolam group (0%) compared to the sevoflurane group (30%).
No significant difference was observed in the Quality of Recovery-15 (QOR-15) score at 24 hours postoperatively between the two groups.

Simplified

BACKGROUND: Postoperative nausea and vomiting (PONV) refers to nausea and vomiting that occurs within 24-h after surgery or in the post-anesthesia care unit (PACU). Previous studies have reported that the use of remimazolam, a newer benzodiazepine (BDZ) hypnotic, for anesthesia results in less PONV. In this study, we compared the rate of PONV between sevoflurane and remimazolam after general anesthesia.

METHODS: In this prospective randomized controlled trial, participants aged 20-80 years who underwent elective laparoscopic cholecystectomy or hemicolectomy were randomized to either the remimazolam or sevoflurane group. The primary outcome was PONV incidence for 24-h after surgery. Secondary outcomes comprised of PONV at 30-min post-surgery, postoperative additional antiemetic use, and Quality of Recovery-15 (QOR-15) score at 24-h postoperatively.

RESULTS: Forty patients were enrolled in the study. The remimazolam group exhibited significantly lower rates of PONV for 24-h after surgery than did the sevoflurane group (remimazolam group vs. sevoflurane group; 5% vs. 45%, P = 0.003, respectively). The use of dexamethasone, a rescue antiemetic administered within 24 h of surgery, was substantially lower in the remimazolam group than in the sevoflurane group (0% in remimazolam vs. 30% in sevoflurane, P = 0.020). The QOR-15 score at 24-h after surgery showed no significant difference between the two groups.

CONCLUSIONS: Compared to sevoflurane, opting for remimazolam as an intraoperative hypnotic may decrease the incidence of PONV and reduce antiemetic use for 24 h after laparoscopic surgery.

Key numbers

5% vs. 45%

PONV Incidence

PONV incidence for remimazolam group vs. sevoflurane group

0% in remimazolam vs. 30% in sevoflurane

Dexamethasone Use

Percentage of patients requiring dexamethasone post-surgery

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Rates of nausea and vomiting after general anesthesia with remimazolam compared to sevoflurane

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