Remimazolam vs. dexmedetomidine for postoperative sedation in oral tumor patients undergoing free flap reconstruction: a randomized controlled pilot trial.

Yun Liu, Likuan Wang, Guoli Xiong, Xudong Yang

Abstract readRandomized Controlled TrialComparative Study

In one paragraph

Trial report in BMC anesthesiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

4 authors.

Yun Liu *Department of Anesthesiology, National Engineering Research Center of Oral Biomaterials, Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Beijing, 100081, China.

Likuan Wang *Department of Anesthesiology, National Engineering Research Center of Oral Biomaterials, Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Beijing, 100081, China.

Guoli XiongDepartment of Anesthesiology, National Engineering Research Center of Oral Biomaterials, Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Beijing, 100081, China.

Xudong YangDepartment of Anesthesiology, National Engineering Research Center of Oral Biomaterials, Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Beijing, 100081, China. kqyangxudong@163.com.

Funding

Bethune Foundation - Perioperative analgesia and sedation research project BCF-RF-WSQZTZJ-202011-037Young Clinical Research Fund of the Chinese Stomatological Association CSA-A2021-02

6 · The paper itself

Abstract

backgroundPatients with oral tumors undergoing free-flap reconstruction require postoperative sedation to improve endotracheal tube tolerance and prevent emergence agitation. While remimazolam offers theoretical hemodynamic advantages over dexmedetomidine, clinical evidence in this context remains limited. This trial compared the efficacy and safety of both agents for sedation after microvascular reconstruction.

methodsIn this randomized, double-blind trial (September 2021-November 2022), 60 patients were enrolled. Upon PACU admission, patients received continuous infusions of remimazolam (0.25 mg·kg⁻¹·h⁻¹) or dexmedetomidine (0.4 µg·kg⁻¹·h⁻¹), titrated to a Ramsay Score of 2-3. The primary outcome was PACU emergence agitation incidence (RASS ≥ + 2). Secondary outcomes included delirium, pain, nausea/vomiting, sleep quality, hospital stay, and complications.

resultsThe final analysis included 57 patients (remimazolam n = 29, dexmedetomidine n = 28) due to consent withdrawal. Emergence agitation incidence was comparable (27.6% vs. 25.0%, p > 0.999; risk difference 2.6% [95% CI: - 21.5-26.7%]). Remimazolam significantly reduced colloid use in PACU (3.4% vs. 32.1%, p = 0.005). No significant differences in secondary outcomes (delirium, pain scores, nausea/vomiting, hospital stay).

conclusionsRemimazolam and dexmedetomidine demonstrated equivalent efficacy in preventing emergence agitation. The significantly reduced colloid requirement with remimazolam suggests enhanced hemodynamic stability, potentially benefiting flap perfusion. Combined with its rapid-offset profile, remimazolam is a viable alternative for postoperative sedation in microvascular reconstruction.

trial registrationChinese Clinical Trial Registry, www.chictr.org.cn , ChiCTR2100048342. Registered on 05/07/2021.

Indexed as

DexmedetomidineFree Tissue FlapsHypnotics and SedativesMouth NeoplasmsPlastic Surgery ProceduresAdultAgedBenzodiazepinesDouble-Blind MethodEmergence DeliriumFemaleHumansMaleMiddle AgedPilot ProjectsBenzodiazepinesDexmedetomidineHypnotics and SedativesremimazolamDexmedetomidineMicrovascular reconstructionOral tumorPostoperative sedationRemimazolam

Identifiers

PMID41053556

DOI10.1186/s12871-025-03346-x

PMCPMC12502151

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.