Discussion
blurred vision, tremors, pain, dizziness, agitation, headache, shivering, flushing,
ADVERSE EVENT, RINGING IN THE EAR
The present study was the first to evaluate RT in general anesthesia for day surgery. RT induction was as rapid as propofol’s. A fast and complete recovery from general anesthesia could be achieved with the use of flumazenil. Although higher BIS values were observed in patients treated with RT, no intraoperative awareness was reported. Vasopressor dosage, injection pain and serum TG levels were decreased in patients who received RT with or without flumazenil compared with propofol.Because minimally invasive surgery is now well established, more procedures can be performed as day surgeries [The dosing we chose for RT in this study was based on the results of Phase II and III clinical trials of RT [RT was found to achieve a similar recovery time from general anesthesia compared with propofol only when patients were treated with flumazenil 10 min after RT discontinuation in this study. It’s worth noting that BIS values were different between the RT combined with flumazenil group and propofol group, which may affect the result of recovery time. However, RT was reported to have a faster recovery from procedural sedation after upper gastrointestinal endoscopy compared with propofol when administered via intermittent IV injection [A recent study reported lower physical comfort and emotional state recovery quality among patients who received remimazolam besylate keeping BIS ranges between 40 and 60 compared with propofol for urologic surgery on POD1 [Adverse events linked to flumazenil include pain on injection, agitation and tremors, flushing, dizziness, sweating or shivering, headache, blurred vision and ringing in the ears [Prior reports suggested that propofol reduces the generation of pro-inflammatory cytokines and exerts a neuroprotective effect by maintaining Th17/Treg cell balance [This study has several limitations. First, because the present study is limited to patients who underwent day surgery with an LMA, the efficacy and safety of RT during procedures that require intubation may be different. Second, NPY was detected before PACU discharge in this study when patients might fully recover from sleep inhibition. Changes in NPY are suggested to be detected before, during and after the procedures in the future study. Third, propofol and RT may reach different levels of anesthesia depth according to the BIS values. The depth of anesthesia may affect the hemodynamic stability and the recovery time. However, BIS monitoring may not properly reflect the depth of anesthesia with remimazolam. Appropriate ranges of BIS and alternative methods to monitor the depth of RT anesthesia need more researches. Fourth, due to limited experience with the drug, the optimal induction dose and the recovery profile of RT still need to be explored. Anesthesiologists need more experience with RT to its full advantage and initiate tapering off early enough to allow for the fastest recovery. Lastly, patients over 75 years old and above ASA II were not included in this study. Hence, the efficacy and safety of RT and flumazenil in older patients and those with comorbidities requires further study. Larger trials with a more vulnerable patient population are needed before RT can be recommended for general use.