ArticleJournal of anesthesia2026
The effect of remimazolam versus propofol on respiratory depression for non-intubated general anesthesia: a randomized controlled trial.
Article in Journal of anesthesia, 2026. 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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Abstract
backgroundThis randomized controlled trial aimed to compare the respiratory safety profiles of remimazolam versus propofol during non-intubated general anesthesia.
methodsThis single-center, randomized controlled trial investigated 200 female patients undergoing Open Excision of Benign Breast Nodule (OEBN) under non-intubated general anesthesia. Participants were randomly assigned to receive either remimazolam or propofol for anesthesia induction and maintenance, combined with remifentanil. We employed the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale for continuous sedation monitoring. The primary endpoint was the incidence of respiratory depression. Secondary outcomes encompassed: postoperative recovery quality, sedation success rate, frequency of respiratory depression episodes, requirement for airway interventions, and occurrence of adverse events (including hemodynamic instability and procedure-related complications).
resultsOf 200 randomized participants, 173 completed all study procedures and were included in the final analysis (Group R: n = 87; Group P: n = 86). The remimazolam group exhibited superior respiratory safety profiles compared to the propofol group, with a lower incidence of respiratory depression (89.7% vs 97.7%, p = 0.031) and a significantly reduced requirement for airway interventions (all p < 0.05). Furthermore, remimazolam predominantly induces mild respiratory depression (73.6%), whereas propofol is more frequently associated with severe respiratory suppression (44.2%). Regarding adverse events, Group R demonstrated markedly lower rates of injection pain (0% vs 39.5%, p < 0.001), hypotension (29.9% vs 46.5%, p = 0.024), and bradycardia (18.4% vs 44.2%, p < 0.001). Patients receiving remimazolam (Group R) demonstrated significantly superior hemodynamic stability compared to the propofol group.
conclusionAlthough both remimazolam and propofol demonstrated a high incidence of respiratory depression, remimazolam was associated with milder respiratory suppression and a reduced need for airway interventions during OEBN with non-intubated general anesthesia. Additionally, it offers better hemodynamic stability and fewer adverse events, making it a safer alternative for such procedures. CLINICAL
trial registrationChiCTR2400089826.
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