Korean journal of anesthesiologyMay 7, 2024

Emergence agitation after nasal surgery: comparing remimazolam and desflurane anesthesia

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Updated Apr 5, 2026

Abstract

The incidence of emergence agitation (EA) was significantly lower in the remimazolam-remifentanil group than in the desflurane-nitrous oxide group (all P < 0.001).

Emergence agitation was assessed using three different scales, all showing lower EA in the remimazolam-remifentanil group.
Heart rate changes during emergence were significantly different between the two anesthesia groups (P = 0.002).
Patients in the remimazolam-remifentanil group reported a lower sense of suffocation postoperatively compared to the desflurane-nitrous oxide group (P = 0.027).
Remimazolam-remifentanil anesthesia may be associated with improved management of hemodynamics during emergence.

Simplified

BACKGROUND: Remimazolam is an ultrashort-acting benzodiazepine. Few studies have evaluated the effects of remimazolam-based total intravenous anesthesia (TIVA) on emergence agitation (EA). This study aimed to compare the incidence and severity of EA between TIVA using remimazolam and desflurane.

METHODS: This prospective randomized controlled study enrolled 76 patients who underwent nasal surgery under general anesthesia. Patients were randomized into two groups of 38 each: desflurane-nitrous oxide (N2O) (DN) and remimazolam-remifentanil (RR) groups. The same protocol was used for each group from induction to emergence, except for the use of different anesthetics during maintenance of anesthesia according to the assigned group: desflurane and nitrous oxide for the DN group and remimazolam and remifentanil for the RR group. The incidence of EA as the primary outcome was evaluated using three scales: Ricker Sedation-Agitation Scale, Richmond Agitation-Sedation Scale, and Aono's four-point agitation scale. Additionally, hemodynamic changes during emergence and postoperative sense of suffocation were compared.

RESULTS: The incidence of EA was significantly lower in the RR group than in the DN group in all three types of EA assessment scales (all P < 0.001). During emergence, the change in heart rate differed between the two groups (P = 0.002). The sense of suffocation was lower in the RR group than in the DN group (P = 0.027).

CONCLUSIONS: RR reduced the incidence and severity of EA in patients undergoing nasal surgery under general anesthesia. In addition, RR was favorable for managing hemodynamics and postoperative sense of suffocation.

Key numbers

84.2% vs. 44.7%

Emergence Agitation Incidence Reduction

Incidence of emergence agitation assessed by Ricker Sedation-Agitation Scale.

5.0 vs. 2.0

Lower Sense of Suffocation

NRS for suffocation scores in the DN and RR groups.

P = 0.002

Heart Rate Changes

Comparison of heart rate changes between DN and RR groups.

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Emergence agitation after nasal surgery: comparing remimazolam and desflurane anesthesia

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