Secondary outcomes
re-sedation, delirium, TG, SE
Sedation success rates were equivalent among the three groups, with 97.4% each (P = 1.000; Table 
Vital signs and bispectral index during the entire procedure. Evaluation of the levels of (During the recovery phase, all of the patients in the RT + flumazenil group received flumazenil. The average dose of flumazenil was 0.27 mg and the maximum dose was 0.70 mg. No re-sedation occurred 60 min after flumazenil administration according to the MOAA/S scores (5.00 ± 0.00 for all three groups) and Aldrete scores (10.00 ± 0.00 for all three groups) in PACU. Time to eye opening, LMA extraction and the third consecutive Aldrete score ≥ 9 were statistically shorter in the propofol group and RT + flumazenil group compared with the RT group (P ≤ 0.001 for all comparisons; Table SpOThere was no postoperative delirium in any of the three groups prior to PACU discharge and on POD 1 and 14. There were no significant between-group differences in MMSE (PACU, P = 0.724; POD1, P = 0.117) or in PostopQRS scores (POD1, P = 0.072; POD14, P = 0.264) compared with baseline measurements (Table 
Cognitive and recovery profile assessmentsData are presented as mean ± SD. The estimated difference is the least-squares mean ± SE change from baseline among the three groups at the corresponding time respectivelyAbbreviations: CI, confidence interval; MOAA/S, Modified Observer’s Alertness/Sedation scale; MMSE, mini-mental state examination; PACU, postanesthesia care unit; POD1, 1 day after surgery; POD14, 14 days after surgery; VAS, visual analogue scale; PostopQRS, post-operative quality of recovery scale; RT, remimazolam tosilate; SD, standard deviation; SE, standard errorWith respect to lipid metabolism, extensive changes in TG were observed in the propofol group in the PACU. The strongest increase of TG after anesthesia was observed in the propofol group compared with the RT with or without flumazenil groups (1.88 ± 1.28 mmol/L, 1.33 ± 0.70 mmol/L, 1.43 ± 0.75 mmol/L, respectively; P < 0.001; Supplementary Fig. 1E). The baseline VLDL measurement in propofol group was significantly lower than that of both RT groups (P < 0.001; Supplementary Fig. 1F). However, following covariance analysis PACU VLDL levels were comparable among the three groups (P = 0.728; Supplementary Fig. 1F). Changes in NPY, which was found to have hypnotic properties and be increased during the sleep inhibition phase [