REMIMAZOLAM was associated with faster anaesthesia recovery without increasing postoperative nausea and vomiting (PONV) risk in patients undergoing breast cancer surgery, according to a randomised controlled trial comparing a remimazolam bridged emergence strategy with continued sevoflurane anaesthesia plus ondansetron.
PONV remains a common concern following surgery, and strategies to reduce complications while improving recovery are important considerations in perioperative care. This study evaluated whether switching from sevoflurane to remimazolam 30 minutes before the end of surgery could influence postoperative outcomes.
The single-centre, double-blind, randomised controlled trial included 92 patients scheduled for radical mastectomy. Participants were randomly assigned to either a remimazolam bridged emergence group or a continued sevoflurane plus ondansetron group.
In the remimazolam group, sevoflurane was discontinued 30 minutes before surgery completion and replaced with remimazolam maintenance at 1 mg/(kg·h). In the comparison group, patients continued receiving sevoflurane and were administered 4 mg ondansetron 30 minutes before the end of surgery.
The study found no statistically significant difference in the incidence of PONV within 24 hours between the two groups, and PONV severity classification was also comparable (p>0.05).
However, patients receiving the remimazolam bridged emergence strategy experienced shorter recovery times compared with those receiving continued sevoflurane with ondansetron. Time to tracheal tube removal, spontaneous breathing recovery, eye opening and orientation recovery were all reduced in the remimazolam group (all p<0.001).
The maximum agitation score during the anaesthesia recovery period was also lower among patients receiving remimazolam compared with the ondansetron group (p<0.001).
The investigators reported that the remimazolam bridged emergence strategy did not increase the risk of PONV following radical mastectomy and was associated with improved recovery characteristics during the perioperative period.
The authors highlighted that the study was not designed as a non-inferiority or equivalence trial, meaning the findings should not be interpreted as demonstrating that the two treatment approaches were equivalent. Instead, the results indicated that remimazolam may provide an alternative emergence strategy that maintains PONV outcomes while supporting faster anaesthesia recovery and reduced emergence agitation.
Further investigation may help clarify the role of remimazolam-based approaches in perioperative management for patients undergoing breast cancer surgery.
Reference
Zhao S et al. Effect of bridging intervention strategy with remimazolam on postoperative nausea and vomiting in patients undergoing breast cancer surgery. Sci Rep. 2026;DOI:10.1038/s41598-026-64173-9
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