Remimazolam for the prevention of emergence agitation in adult following nasal surgery under general anesthesia: A randomized controlled study

Remimazolam for the prevention of emergence agitation in adult following nasal surgery under general anesthesia: A randomized controlled study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Remimazolam for the prevention of emergence agitation in adult following nasal surgery under general anesthesia: A randomized controlled study Qiaomin Xu, Jimin Wu, Mengting Ai, Haiyan Lan, Hong Dai, Xiaoli Dong, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4270156/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The purpose of this study was to evaluate the effectiveness of postoperative use of remimazolam in preventing emergence agitation (EA) in adult following nasal surgery. In total, 86 patients underwent nasal surgery were randomly divided into two groups. Propofol, sufentanil and cis-atracuriumwere used for induction of anaesthesia, then sevoflurane concentration and propofol were used for maintenance of anaesthesia. After surgery, patients were randomly assigned to receive either remimazolam 0.1 mg/kg (Group R, n = 43) or 0.9% normal saline (Group C, n = 43). The outcomes included the incidence of EA, severe EA, extubation time, length of PACU stay and the maximal RSAS score. In this study. The incidence of EA was lower in Group R than in Group C (21% vs 49%, P = 0.007). The incidence of severe EA was also lower in Group R than in Group C (2% vs 19%, P = 0.035). The maximal RSAS score during emergence was lower in Group R (4 [4–4]) than in Group C (5 [4–6]) ( P < 0.001). Therefore, postoperative injection of remimazolam 0.1 mg/kginto adult patients underwent nasal surgerycan significantly reduce the incidence of EA and severe EA. Biological sciences/Drug discovery Biological sciences/Drug discovery/Drug delivery Remimazolam Nasal surgery Emergence agitation General anesthesia Figures Figure 1 Figure 2 Introduction Emergence agitation (EA) is a common complication after general anesthesia, and its clinical manifestations are characterized by delirium, confusion, acute, agitation and violent behavior. 1 If not handled properly, the patient may be seriously injured, such as aggravating pain, bleeding, self-extubation, or even falling out of the bed, which will cause great harm to the patient. 2 Furthermore, it may increase the demand on human resources and cause medical staff injuries. While the pathogenesis of EA is unclear, Liang et al. study showed that the incidence of EA in adults who used continuous inhalation of sevoflurane to maintain anesthesia was 53%. 3 Another study showed that the incidence of EA in adult ENT (ear, nose, and throat) surgical under general anesthesia is as high as 55.4%. 4 The sense of asphyxia caused by nasal packing in nasal surgery makes patients more frequently appear restless during the recovery period. 5 Therefore, patients underwent nasal surgery need appropriate sedation and analgesia during the recovery period to improve comfort and reduce the incidence of EA. Remimazolam is a new type of ultrashort-acting benzodiazepine, which is characterized by rapid onset sedation, rapid recovery, and mild cardiovascular inhibition. 6 A clinical study indicated that remimazolam can prevent emergence delirium in children after tonsillectomy and adenoidectomy under sevoflurane anesthesia. 7 Therefore, we designed a prospective, double-blind, randomized study to explore the effect of postoperative intravenous remimazolam on EA of nasal surgery in adults. Methods Ethics and registration This study was registered in the Chinese Clinical Trial Registry (www.chictr.org.cn, registration number: ChiCTR2300075300, 31/08/2023). The study was approved by the medical ethics committee of The Sixth Affiliated Hospital of Wenzhou Medical University (approval no. 2023-137), and all enrolled patients provided written informed consent. Patient inclusion and exclusion criteria This study involved 86 adult patients who were admitted to Lishui People’s Hospital (Wenzhou Medical University Lishui Hospital) for nasal surgery from September 2023 to October 2023. The inclusion criteria were (1) elective nasal surgery, (2) age of 18 to 65 years, (3) an American Society of Anesthesiologists physical status of Ⅰ or II, and (4) a body mass index of 18.5 to 27.9 kg/m 2 . The exclusion criteria were (1) preoperative mental disorders or communication difficulties, (2) Patients with severe arrhythmia, such as sick sinus syndrome, second and third degree atrioventricular block, or heart rate (HR) <50 beats/minute); (3) Preoperative diagnosis of respiratory failure (PaO 2 <60mmHg), New York Heart Association (NYHA) cardiac function grading III or IV, (4) patients scheduled to be sent to the intensive care unit after surgery and (5) allergy to benzodiazepines, or have a long-term history of benzodiazepines. Randomization and masking Patients were randomly assigned into two groups (Group L and Group C) by computer-generated random numbers, 43 patients in each group. We discreetly placed the randomization results in envelopes until the end of the study. Study drugs were prepared by a nurse who was not involved in other parts of the study. Both remimazolam and saline are colorless liquids, and they were digitally encoded so that the researchers who were responsible for postoperative follow-up and data processing were blinded to the group allocation during the whole study period. All anaesthetists and patients were also blinded to the group allocation. Perioperative management and interventions No premedication was administered in all surgical patients. Upon arrival in the operating room, all patients underwent pulse oxygen saturation, mean arterial pressure (MAP), and electrocardiogram monitoring using a Carestation 620 A2 monitor (GE Healthcare, Chicago, IL, USA). The depth of general anesthesia of patients was continuously monitored by the bispectral index (BIS) sensor (Canwell Medical Co., Ltd., Jinhua, Zhejiang, China). All patients were anesthetized using standard protocols as follows. Anesthesia was induced with 2.0 to 2.5 mg/kg propofol (Beijing Fresenius Kabi Pharmaceutical Co., Ltd., Beijing, China), 0.4 to 0.5 mg/kg sufentanil (Yichang Humanwell Pharmaceutical Co., Ltd., Yichang, China) and 0.2 mg/kg cis-atracurium (Jiangsu Hengrui Pharmaceutical Co., Ltd., Jiangsu, China). After successful induction of general anesthesia, endotracheal intubation was performed. Volume-controlled mechanical ventilation was administered to maintain an end-tidal carbon dioxide partial pressure of 35 to 45 mmHg. Anesthesia was maintained with inhalation of 1.5 to 3.5% sevoflurane concentration (Jiangsu Hengrui Pharmaceutical Co., Ltd., Jiangsu, China) and 4 to 12mg/kg/h propofol (Beijing Fresenius Kabi Pharmaceutical Co., Ltd., Beijing, China) were used for maintenance of anaesthesia. The sevoflurane concentration was controlled according to the haemodynamics and BIS value of each patient (maintaining both MAP and HR changes within 20% of baseline, and a BIS value of 40 to 60). During the surgery, sufentanil and cis-atracurium were injected as needed. When the surgery was over, the anesthetic drugs was stopped immediately. Then the intervention measures was started: (1) Group R (n=43): 0.1mg/kg remimazolam was injected intravenously after surgery, and the infusion time was 1 min. (2) Group C (n = 43), normal saline was injected intravenously after surgery, and the volume and rate changes were the same as those in Group R. When we confirmed the return of neuromuscular function by using a train-of-four monitor, neuromuscular blocking was reversed with glycopyrrolate 0.004 mg/kg and 0.02 mg/kg neostigmine. Then, we administered verbal stimulation to the patients every 30 seconds, patients were extubated once they regained consciousness and were able to obey verbal commands. The RSAS scores were assessed by independent anesthesiologists every 10 seconds who were blinded to the anesthetic methods administered in this study. Finally, all patients were transferred to the post-anesthesia care unit (PACU) for close observation. A well-trained nurse blinded to randomized study group evaluated pain intensity by using the NRS (numeric rating scale) (range, 0-10, with higher scores indicating worse pain) every 5 minutes. Nonsteroidal anti-inflammatory drugs were administered when the NRS score ≥ 5. Patients were discharged from the PACU when their Aldrete score was ≥ 9. 8 The following evaluation time points were defined: T0: admission (basal); T1: at the end of the surgery; T2: after investigational drug infusion; T3: tracheal extubation; T4: 2 min after tracheal extubation; T5: 5 min after tracheal extubation. Outcomes Primary outcome The primary outcome was the incidence of EA. Emergence was defined as the time interval from the end of surgery to 2 minutes after tracheal extubation. During emergence, EA was defined as the Riker sedation–agitation scale (RSAS) >4 score, 1 = unarousable, no response to noxious stimuli; 2 = very sedated, arouse to physical stimuli but dose not communicate; 3 = sedated, awakens to verbal commands or gentle shaking but drifts off again; 4 = calm, awakens easily, follows verbal commands; 5 = agitated, anxious or mildly agitated, calms down to verbal instructions; 6 = very agitated, requiring physical restraint and frequent verbal reminding of limits; and 7 = dangerous agitation, pulling at tracheal tube, trying to remove catheters or striking at staff. 9 Secondary outcomes The secondary outcomes were as follows. The incidence of severe EA (RSAS = 7) and the maximal RSAS score during emergence were also recorded. Recovery characteristics included extubation time, the length of PACU stay and Maximum NRS score in PACU. Intraoperative characteristics included intraoperative sufentanil dosage, duration of surgery, sevoflurane used time , amount of intraoperative fluid and blood loss. Haemodynamic parameters (including MAP and HR) were recorded at six different time points: T0, T1, T2, T3,T4, and T5. The observation period of postoperative adverse events was from the end of surgery to discharged from the PACU. Postoperative adverse events included hypotension (MAP ≤ 70% of baseline and/or < 65 mmHg), hypertension (MAP ≥ 120% of baseline), bradycardia (HR ≤ 45 beats/min), and tachycardia (HR of ≥ 120% of baseline), 10 postoperative nausea and vomiting (PONV), laryngospasm, cough (Cough level: 0= no coughing; 1= single cough; 2= persistent cough lasting< 5s; 3= persistent cough lasting ≥ 5s) .If these events occurred, intravenous injection of drugs such as ephedrine, urapidil, atropine, esmolol, and tropisetron can be used to treate. The incidence of postoperative delirium (POD) within 3 days after surgery, which was assessed by Confusion Assessment Method. 11 Sample size and statistical analysis A total of 40 patients completed this pre-experiment. According to the results of the pre-experiment, the incidence of EA was 55% in Group C and 25% in Group R. Therefore, a sample size of 76 patients was needed to provide a power of 80% and a significance of 0.05. Considering a 10% attrition rate, we concluded to enroll 86 patients for this study (43 patients in each group). The data processing and analyses were performed using SPSS 20.0 statistical software (IBM Corp., Armonk, NY, USA). All data are presented as mean ± standard deviation, number (percentage), or median (interquartile range) as appropriate. The normality of distribution was assessed with the Shapiro-Wilk test. Normally distributed data were compared between the groups using an independent-samples t-test, and non-normally distributed data were compared between the groups using the Mann–Whitney U test. Repeated-measures ANOVA was used for intra group comparisons, and Bonferroni Corrections to determine the P value significance threshold. The chi-square test or Fisher’s exact test was used for comparison of enumeration data between the groups. The significance level for this analysis was set at α = 0.05. Results In total, 96 patients were initially screened for eligibility, 2 patients met the exclusion criteria and 8 patients declined to participate in this study. Finally, data for 43 patients in Group R and 43 patients in Group C were analyzed (Fig. 1 ). Patient characteristics and operation details The patient baseline characteristics were statistically similar between the two groups (Table 1 ). Table 1 Patient baseline characteristics Group R (n = 43) Group C (n = 43) P Age ( years ) 42.0 ± 11.7 42.8 ± 11.5 0.732 Height ( cm ) 168.9 ± 6.5 168.9 ± 6.7 0.994 Weight ( kg ) 72.6 ± 7.4 70.4 ± 8.1 0.194 Sex ( Male / Female ) 10/33 15/28 0.235 ASA ( Ⅰ / Ⅱ ) 11/32 9/34 0.610 Level of education, n (%) 0.644 <Elementary school 4 6 Elementary school 14 16 ≥Secondary school 25 21 Notes: Data were presented as mean ± standard deviation. No statistically significant differences between groups were noted. Abbreviations: ASA, American Society of Anesthesiologists. There were no significant difference in the incidence of extubation time, the length of PACU stay, NRS for pain, intraoperative sufentanil dosage, duration of surgery, amount of intraoperative fluid and blood loss between the two groups (Table 2 ). Table 2 Intra- and Postoperative Characteristics Group R (n = 43) Group C (n = 43) P Extubation time (min) 21.0 ± 4.2 20.9 ± 3.8 0.915 Length of PACU stay (min) 23.3 ± 3.2 22.5 ± 2.9 0.246 Maximum NRS score in PACU 2 ( 1 – 2 ) 2 ( 1 – 3 ) 0.450 Type of surgery [ n (%) ] 0.892 Septoplasty 20 19 Ethmoidectomy 6 5 Both Septoplasty and ethmoidectomy 17 19 Type of nasal packing 0.747 Unilateral 5 6 Bilateral 38 37 Duration of surgery (min) 53.6 ± 15.6 53.0 ± 13.1 0.852 Sevoflurane used time (min) 59.1 ± 15.0 58.6 ± 12.7 0.856 Intraoperative sufentanil dosage (µg) 30 (28–30) 28 (28–30) 0.231 Amount of intraoperative fluid (ml) 529.1 ± 148.0 569.5 ± 86.7 0.126 Blood loss (ml) 15 (10–25) 10 ( 10 – 20 ) 0.477 Notes: Data were presented as mean ± standard deviation, or median (interquartile range). No statistically significant differences between groups were noted. Abbreviations:PACU, post anesthesia care unit. NRS, numeric rating scale. The incidence of EA was significantly lower in Group R than in Group C (21% vs 49%, P = 0.007). The incidence of severe EA was also significantly lower in Group R than in Group C (2% vs 19%, P = 0.035). The maximal RSAS score during emergence was significantly lower in Group R (4 [4–4]) than in Group C (5 [4–6]), ( P < 0.001) (Table 3 ). Table 3 Emergence agitation related outcomes Group R (n = 43) Group C (n = 43) P Emergence agitation, n (%) 9(21)* 21(49) 0.007 Severe emergence agitation, n (%) 1( 2 )* 8( 19 ) 0.035 Maximal RSAS score during emergence 4 ( 4 – 4 )* 5 ( 4 – 6 ) < 0.001 Note: Data were presented as median (interquartile range), or number (percentage) as appropriate. * p < 0.05, compared with group C. Abbreviations: RSAS, Riker sedation–agitation scale During the emergence period, the hemodynamics of group R showed more stable changes than group C (Fig. 2 ). The incidence of hypertension was significantly lower in Group R than in Group C (5% vs 21%, P = 0.024) and grade of cough was significantly lower in Group R (1 [0–2]) than in Group C (2 [1–2]) ( P = 0.008). In addition, there were no significant difference in the incidence of hypotension, bradycardia, tachycardia, PONV, laryngospasm and POD between the two groups (Table 4 ). Table 4 Postoperative Adverse Events Group R (n = 43) Group C (n = 43) P Hypotension, n (%) 0(0) 0(0) - Hypertension, n (%) 2( 5 )* 9(21) 0.024 Bradycardia, n (%) 2( 5 ) 4( 9 ) 0.672 Tachycardia, n (%) 9(21) 12(28) 0.136 PONV, n (%) 4( 9 ) 2( 5 ) 0.672 Laryngospasm, n (%) 0(0) 2( 5 ) 0.494 Grade of cough 1(0–2)* 2 ( 1 – 2 ) 0.008 POD, n (%) 0(0) 0(0) - Note: Data were presented as median (IQR) or number (percentage) as appropriate. * p < 0.05, compared with group C. Abbreviations:PONV, postoperative nausea and vomiting; POD, postoperative delirium. Abbreviations:HR, heart rate; MAP, mean arterial pressure. Discussion This study suggests that intravenous injection of remimazolam at a dose of 0.1 mg/kg at the end of nasal surgery in adult patients can significantly reduce the incidence of EA and severe EA, and also significantly reduce the maximal RSAS score during the emergence. In addition, this intervention can also reduce the incidence of hypertension and grade of cough, thereby presenting a stable hemodynamic. The incidence of EA is related to various factors, including pain, endotracheal intubation, inhalation of anesthetics, preoperative anxiety, male gender, age, and type of surgical procedure. Among them, oral surgery and ENT surgery have the highest incidence of EA, with an incidence of 60% and 55.4%, respectively. 4 Previous studies have revealed that the continuous presence of endotracheal intubation during the recovery period causes significant pain in patients, which is the most common cause of EA. 12 A study showed that intraoperative infusion of dexmedetomidine significantly reduced the incidence of EA in adult patients undergoing nasal surgery (from 52–28%). 13 The result is similar to that of this study, which decreased from 49–21%. This may be due to the fact that both dexmedetomidine and remimazolam have the effect of inhibiting patients' rapid awakening, while effectively reducing the intolerable stimulation caused by tracheal intubation and nasal packing. In a recent study by Yang et al., which selected children undergoing tonsillectomy and adenoidectomy under sevoflurane general anesthesia, intravenous administration of 0.2 mg/kg remimazolam at the end of surgery significantly reduced the incidence and severity of emergence delirium. 7 This study is similar to our research results, which show that the use of intravenous remimazolam at the end of surgery can effectively reduce the maximal RSAS score, thereby reducing the incidence of EA and severe EA. The clinical manifestation of EA included confusion, disorientation, crying, moaning, shouting, or screaming. 14 These factors may trigger severe fluctuations in hemodynamics, thereby increasing the risk of cardiovascular and cerebrovascular diseases. In this study, Group R showed more stable hemodynamic during the emergence, and the incidence of hypertension and the grade of cough were significantly lower than Group C. Remimazolam has received high attention from many scholars since its launch. Recent studies have shown that remimazolam can not only reduce the incidence of EA during hip replacement surgery in the elderly, but also maintain more stable hemodynamic parameters. 15 In addition, compared with dexmedetomidine, remimazolam is also effective in reducing the incidence of EA in elderly patients after orthopedic surgery. 16,17 The results also showed that there was no significant difference in extubation time and length of PACU stay between the two groups. This may be related to the pharmacological properties of remimazolam, which has been confirmed by multiple studies to have no effect on postoperative recovery time. 18,19,20 Although there are several limitations in this study, it is still valuable to explore its results. Firstly, during the experimental process, we only used a single intravenous infusion dose of remimazolam, which was 0.1 mg/kg. Whether this dose is the optimal effective dose remains to be further confirmed by subsequent studies. Secondly, this study is a single-center trial, and it is necessary to conduct multi-center studies in the future to verify the reliability. Despite the above limitations, this study still has important value. Because this study is not only a prospective, double-blind randomized controlled trial; in addition, the subjects were selected from a specific group and standardized anesthesia methods were used, which improved the scientificity and credibility of the research results. Conclusions After the surgery, the incidence of EA and severe EA in adult nasal surgery can be effectively reduced by intravenous injection of 0.1mg/kg of remimazolam. In addition, the intervention measures will not lead to the extension of extubation time and the length of PACU stay, nor increase the risk of postoperative adverse events. For nasal surgery, this is a safe and effective intervention strategy. Declarations Data availability Data is provided within the manuscript or supplementary information files. Acknowledgments We thank the patients who participated in this study. Author Contributions All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work. Competing interests Te authors declare no competing interests Funding Statement None Ethics Approval and Consent to Participate This trial was performed in accordance with the Declaration of Helsinki and the Chinese Clinical Trial Specifications. The study was approved by the Medical Ethics Committee of Lishui People's Hospital ( Wenzhou Medical University Lishui Hospital ) (approval No. 2023-137), and was registered in the Chinese Clinical Trial Registry (www.chictr.org.cn; registration number: ChiCTR2300075300, 31/08/2023). Written informed consent was obtained from all participants. The study protocol followed the CONSORT guidelines. The study protocol was performed in the relevant guidelines. References Lepousé C, Lautner CA, Liu L, et al. Emergence delirium in adults in the post-anaesthesia care unit. Br J Anaesth. 2006;96(6):747–753. doi: 10.1093/bja/ael094 Munk L, Andersen G, Møller AM. Post-anaesthetic emergence delirium in adults: incidence, predictors and consequences. Acta Anaesthesiol Scand. 2016;60(8):1059–1066. doi: 10.1111/aas.12717 Liang C, Ding M, Du F, Cang J, Xue Z. Sevoflurane/propofol coadministration provides better recovery than sevoflurane in combined general/epidural anesthesia: a randomized clinical trial. J Anesth. 2014;28(5):721–726. doi: 10.1007/s00540-014-1803-0 Yu D, Chai W, Sun X, et al. Emergence agitation in adults: risk factors in 2,000 patients. Can J Anaesth. 2010;57(9):843–848. doi: 10.1007/s12630-010-9338-9 Mo JH, Han DH, Shin HW, et al. No packing versus packing after endoscopic sinus surgery: pursuit of patients' comfort after surgery. Am J Rhinol. 2008;22(5):525–528. doi: 10.2500/ajr.2008.22.3218 Lee A, Shirley M. Remimazolam: A Review in Procedural Sedation. Drugs. 2021;81(10):1193–1201. doi: 10.1007/s40265-021-01544-8 Yang X, Lin C, Chen S, et al. Remimazolam for the prevention of emergence delirium in children following tonsillectomy and adenoidectomy under sevoflurane anesthesia: a randomized controlled study. Drug Des Devel Ther. 2022;16:3413–3420. doi: 10.2147/DDDT.S381611 Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995;7(1):89–91. doi: 10.1016/0952-8180(94)00001-k Lee S, Sohn JY, Hwang IE, et al. Effect of a repeated verbal reminder of orientation on emergence agitation after general anaesthesia for minimally invasive abdominal surgery: a randomised controlled trial. Br J Anaesth. 2023;130(4):439–445. doi: 10.1016/j.bja.2022.12.009 Amin SM, Hasanin A, ElSayed OS, et al. Comparison of the hemodynamic effects of opioid-based versus lidocaine-based induction of anesthesia with propofol in older adults: a randomized controlled trial. Anaesth Crit Care Pain Med. 2023;42(4):101225. doi: 10.1016/j.accpm.2023.101225 Flanagan NM, Spencer G. Informal caregivers and detection of delirium in postacute care: a correlational study of the confusion assessment method (CAM), confusion assessment method-family assessment method (CAM-FAM) and DSM-IV criteria. Int J Older People Nurs. 2016;11(3):176–183. doi: 10.1111/opn.12106 Barreto ACTP, Rangel da Rocha Paschoal AC, Barbosa Farias C, et al. Fatores de risco associados a delírio no despertar da anestesia em crianças submetidas à cirurgia ambulatorial [Risk factors associated with anesthesia emergence delirium in children undergoing outpatient surgery]. Braz J Anesthesiol. 2018;68(2):162–167. doi: 10.1016/j.bjan.2017.11.002 Kim SY, Kim JM, Lee JH, et al. Efficacy of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery. Br J Anaesth. 2013;111(2):222–228. doi: 10.1093/bja/aet056 Jo JY, Jung KW, Kim HJ, et al. Effect of total intravenous anesthesia vs volatile induction with maintenance anesthesia on emergence agitation after nasal surgery: a randomized clinical trial. JAMA Otolaryngol Head Neck Surg. 2019;145(2):117–123. doi: 10.1001/jamaoto.2018.3097 Duan J, Ju X, Wang X, et al. Effects of remimazolam and propofol on emergence agitation in elderly patients undergoing hip replacement: a clinical, randomized, controlled study. Drug Des Devel Ther. 2023;17:2669–2678. doi: 10.2147/DDDT.S419146 Deng Y, Qin Z, Wu Q, et al. Efficacy and safety of remimazolam besylate versus dexmedetomidine for sedation in non-Intubated older patients with agitated delirium after orthopedic surgery: a randomized controlled trial. Drug Des Devel Ther. 2022;16:2439–2451. doi: 10.2147/DDDT.S373772 Yang JJ, Lei L, Qiu D, et al. Effect of remimazolam on postoperative delirium in older adult patients undergoing orthopedic surgery: a prospective randomized controlled clinical trial. Drug Des Devel Ther. 2023;17:143–153. doi: 10.2147/DDDT.S392569 Lee HJ, Lee HB, Kim YJ, et al. Comparison of the recovery profile of remimazolam with flumazenil and propofol anesthesia for open thyroidectomy. BMC Anesthesiol. 2023;23(1):147. doi: 10.1186/s12871-023-02104-1 Ko CC, Hung KC, Illias AM, et al. The use of remimazolam versus propofol for induction and maintenance of general anesthesia: A systematic review and meta-analysis. Front Pharmacol. 2023;14:1101728. doi: 10.3389/fphar.2023.1101728 Liao YQ, Min J, Wu ZX, et al. Comparison of the effects of remimazolam and dexmedetomidine on early postoperative cognitive function in elderly patients with gastric cancer. Front Aging Neurosci. 2023;15:1123089. doi: 10.3389/fnagi.2023.1123089 Additional Declarations No competing interests reported. Supplementary Files Data.xls Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4270156","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":301256130,"identity":"082f99a8-755a-4651-89a1-cced96583d7d","order_by":0,"name":"Qiaomin Xu","email":"","orcid":"","institution":"Lishui People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qiaomin","middleName":"","lastName":"Xu","suffix":""},{"id":301256131,"identity":"9baf38a7-09c1-45e0-bff1-0e71e7d04c8d","order_by":1,"name":"Jimin Wu","email":"","orcid":"","institution":"Lishui People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jimin","middleName":"","lastName":"Wu","suffix":""},{"id":301256132,"identity":"085b6860-6fc4-49ca-8a64-9b616d657bff","order_by":2,"name":"Mengting Ai","email":"","orcid":"","institution":"Lishui People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mengting","middleName":"","lastName":"Ai","suffix":""},{"id":301256133,"identity":"c26e3295-0dbf-4979-950a-706e2c6f3a59","order_by":3,"name":"Haiyan Lan","email":"","orcid":"","institution":"Lishui People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Haiyan","middleName":"","lastName":"Lan","suffix":""},{"id":301256134,"identity":"faf17ae7-de45-4c00-9ce6-ba4a7fb3f5c4","order_by":4,"name":"Hong Dai","email":"","orcid":"","institution":"Lishui People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hong","middleName":"","lastName":"Dai","suffix":""},{"id":301256135,"identity":"019965cb-ca15-4297-a595-39ba983d84ae","order_by":5,"name":"Xiaoli Dong","email":"","orcid":"","institution":"Lishui People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaoli","middleName":"","lastName":"Dong","suffix":""},{"id":301256136,"identity":"97a1af91-31a5-4a8c-afed-1f90f31ea2e6","order_by":6,"name":"Gongchen Duan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYBACfvbGxgcf/0jU97M3EKlFsudws+HMBgvGmT0HiNRicCO9TZq3oYJxw40EYrWcOdggwbtDglly5uONNxhqbKIJO+x4Y4OB5BkJNn7ptGILhmNpuQ2EtPABbUkwYJPgkZydYybB2HCYsBaGG4kNBxLYJCQMbp4hUovAjcTGhoNtEgYGN3iI1CLZc7CZseGMRIJkD9AvCcT4hZ+9/fnvPxV1Cfzshzfe+FBjQ4RfkICBRAIpyiFaSNUxCkbBKBgFIwMAALO5RYo//SCrAAAAAElFTkSuQmCC","orcid":"","institution":"Lishui People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Gongchen","middleName":"","lastName":"Duan","suffix":""}],"badges":[],"createdAt":"2024-04-15 13:43:54","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4270156/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4270156/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":56477903,"identity":"f45b28c4-7337-4409-8d8d-a4ca5eaea652","added_by":"auto","created_at":"2024-05-14 17:49:33","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":38632,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of this study\u003c/p\u003e","description":"","filename":"Figure1Flowchartofthisstudy.png","url":"https://assets-eu.researchsquare.com/files/rs-4270156/v1/54fdfc7eb966f5f5f3299407.png"},{"id":56477904,"identity":"8d7e283a-8fb8-465e-b33c-a00cf27a0a40","added_by":"auto","created_at":"2024-05-14 17:49:33","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":123329,"visible":true,"origin":"","legend":"\u003cp\u003eHR and MAP changes during operation and emergence. (a) HR, and (b) MAP. T0: admission (basal); T1: at the end of the surgery; T2: after investigational drug infusion ; T3: tracheal\u0026nbsp;extubation; T4: 2 min after tracheal\u0026nbsp;extubation; T5: 5 min after tracheal\u0026nbsp;extubation. Data were presented as mean ± standard deviation.\u003csup\u003e *\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05 compared with Group C. \u003csup\u003e#\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05 compared with T0 in each group.\u003c/p\u003e\n\u003cp\u003eAbbreviations:HR, heart rate; MAP, mean arterial pressure.\u003c/p\u003e","description":"","filename":"Figure2Haemodynamic.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4270156/v1/d18c89b3bed69250ec56d01d.jpg"},{"id":60550380,"identity":"32909e36-89ca-402e-b083-c217a698cd49","added_by":"auto","created_at":"2024-07-18 05:02:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":647367,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4270156/v1/64a3b20a-95fb-4121-acd1-95e8a9d15e64.pdf"},{"id":56477905,"identity":"8fdc3c22-59f1-4133-b0ba-c99f67d42e69","added_by":"auto","created_at":"2024-05-14 17:49:34","extension":"xls","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":2504704,"visible":true,"origin":"","legend":"","description":"","filename":"Data.xls","url":"https://assets-eu.researchsquare.com/files/rs-4270156/v1/6740a368d521e8541cfa948e.xls"}],"financialInterests":"No competing interests reported.","formattedTitle":"Remimazolam for the prevention of emergence agitation in adult following nasal surgery under general anesthesia: A randomized controlled study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEmergence agitation (EA) is a common complication after general anesthesia, and its clinical manifestations are characterized by delirium, confusion, acute, agitation and violent behavior.\u003csup\u003e1\u003c/sup\u003e If not handled properly, the patient may be seriously injured, such as aggravating pain, bleeding, self-extubation, or even falling out of the bed, which will cause great harm to the patient.\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u0026nbsp; Furthermore, it may increase the demand on human resources and cause medical staff injuries. While the pathogenesis of EA is unclear,\u0026nbsp;Liang et al. study showed that the incidence of EA in adults who used continuous inhalation of sevoflurane to maintain anesthesia was 53%.\u003csup\u003e3\u003c/sup\u003e Another study showed that\u0026nbsp;the incidence of EA in adult ENT (ear, nose, and throat) surgical under general anesthesia is as high as 55.4%.\u003csup\u003e4\u003c/sup\u003e The sense of asphyxia caused by nasal packing in nasal surgery makes patients more frequently appear restless during the recovery period.\u003csup\u003e5\u0026nbsp;\u003c/sup\u003eTherefore, patients underwent nasal surgery need appropriate sedation and analgesia during the recovery period to improve comfort and reduce the incidence of EA.\u003c/p\u003e\n\u003cp\u003eRemimazolam is a new type of ultrashort-acting benzodiazepine, which is characterized by rapid onset\u0026nbsp;sedation, rapid recovery, and mild cardiovascular inhibition.\u003csup\u003e6\u003c/sup\u003e A clinical study indicated that remimazolam can prevent emergence delirium in children after tonsillectomy and adenoidectomy under sevoflurane anesthesia.\u003csup\u003e7\u0026nbsp;\u003c/sup\u003eTherefore, we designed a prospective, double-blind, randomized study to explore the effect of postoperative intravenous remimazolam on EA of nasal surgery in adults.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics and registration\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was registered in the Chinese Clinical Trial Registry (www.chictr.org.cn, registration number: ChiCTR2300075300, 31/08/2023). The study was approved by the medical ethics committee of The Sixth Affiliated Hospital of Wenzhou Medical University (approval no. 2023-137), and all enrolled patients provided written informed consent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePatient inclusion and exclusion criteria\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study involved 86\u0026nbsp;adult\u0026nbsp;patients who were admitted to Lishui People’s Hospital (Wenzhou Medical University Lishui Hospital) for\u0026nbsp;nasal surgery\u0026nbsp;from September 2023 to October 2023.\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria were (1) elective\u0026nbsp;nasal surgery,\u0026nbsp;(2) age of 18 to 65 years, (3) an American Society of Anesthesiologists physical\u0026nbsp;status of Ⅰ or II, and (4) a body mass index of 18.5 to 27.9 kg/m\u003csup\u003e2\u003c/sup\u003e. The exclusion criteria were (1) preoperative mental disorders or communication difficulties, (2) Patients with severe arrhythmia, such as sick sinus syndrome, second and third degree atrioventricular block, or heart rate (HR) \u0026lt;50 beats/minute); (3) Preoperative diagnosis of respiratory failure (PaO\u003csub\u003e2\u003c/sub\u003e\u0026lt;60mmHg), New York Heart Association (NYHA) cardiac function grading III or IV, (4) patients scheduled to be sent to the intensive care unit after surgery and (5)\u0026nbsp;allergy to benzodiazepines, or have a long-term history of benzodiazepines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eRandomization and masking\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients were randomly assigned into two groups (Group L and Group C) by computer-generated random numbers, 43 patients in each group.\u0026nbsp;We discreetly placed the randomization results in envelopes until the end of the study. Study drugs were prepared by a nurse who was not involved in other parts of the study. Both remimazolam\u0026nbsp;and saline are colorless liquids, and they were digitally encoded so that the researchers who were responsible for postoperative follow-up and data processing were blinded to the group allocation during the whole study period. All anaesthetists and patients were also blinded to the group allocation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePerioperative management and interventions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo premedication was administered in all surgical patients. Upon arrival in the operating room, all patients underwent pulse oxygen saturation, mean arterial pressure (MAP), and electrocardiogram monitoring using a Carestation 620 A2 monitor (GE Healthcare, Chicago, IL, USA). The depth of general anesthesia of patients was continuously monitored by the bispectral index (BIS) sensor (Canwell Medical Co., Ltd., Jinhua, Zhejiang, China). All patients were anesthetized using standard protocols as follows. Anesthesia was induced with 2.0 to 2.5 mg/kg propofol (Beijing Fresenius Kabi Pharmaceutical Co., Ltd., Beijing, China), 0.4 to 0.5\u0026nbsp;mg/kg sufentanil (Yichang Humanwell Pharmaceutical Co., Ltd., Yichang, China) and 0.2 mg/kg cis-atracurium (Jiangsu Hengrui Pharmaceutical Co., Ltd., Jiangsu, China). After successful induction of general anesthesia, endotracheal intubation was performed. Volume-controlled mechanical ventilation was administered to maintain an end-tidal carbon dioxide partial pressure of 35 to 45 mmHg. Anesthesia was maintained with inhalation of\u0026nbsp;1.5 to 3.5%\u0026nbsp;sevoflurane\u0026nbsp;concentration\u0026nbsp;(Jiangsu Hengrui Pharmaceutical Co., Ltd., Jiangsu, China)\u0026nbsp;and\u0026nbsp;4 to 12mg/kg/h propofol (Beijing Fresenius Kabi Pharmaceutical Co., Ltd., Beijing, China)\u0026nbsp;were used for maintenance of anaesthesia. The sevoflurane concentration was controlled according to the haemodynamics and\u0026nbsp;BIS value\u0026nbsp;of each patient (maintaining both MAP and HR changes within 20% of baseline, and\u0026nbsp;a BIS value of 40 to 60). During the\u0026nbsp;surgery,\u0026nbsp;sufentanil and cis-atracurium were injected as needed. When the surgery was over, the anesthetic drugs was stopped immediately. Then the intervention measures was started: (1) Group R (n=43): 0.1mg/kg remimazolam was injected intravenously after surgery, and the infusion time was 1 min. (2) Group C (n = 43), normal saline was injected intravenously after surgery, and the volume and rate changes were the same as those in Group R.\u0026nbsp;When we confirmed the return of neuromuscular function by using a train-of-four monitor, neuromuscular blocking was reversed with glycopyrrolate 0.004 mg/kg and 0.02 mg/kg neostigmine. Then, we administered verbal stimulation to the patients every 30 seconds, patients were extubated once they regained consciousness and were able to obey verbal commands. The\u0026nbsp;RSAS\u0026nbsp;scores were assessed by independent anesthesiologists every 10 seconds who were blinded to the anesthetic methods administered in this study.\u0026nbsp;Finally, all patients were transferred to the post-anesthesia care unit (PACU) for close observation.\u0026nbsp;A well-trained nurse blinded to randomized study group evaluated pain intensity by using the NRS (numeric rating scale) (range, 0-10, with higher scores indicating worse pain) every 5 minutes. Nonsteroidal anti-inflammatory drugs were administered when the NRS score\u0026nbsp;≥\u0026nbsp;5.\u0026nbsp;Patients were discharged from the PACU when their Aldrete score was ≥ 9. \u003csup\u003e8\u003c/sup\u003e The following evaluation time points were defined: T0: admission (basal); T1: at the end of the\u0026nbsp;surgery; T2: after investigational drug infusion; T3: tracheal\u0026nbsp;extubation; T4: 2 min after tracheal\u0026nbsp;extubation; T5: 5 min after tracheal\u0026nbsp;extubation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eOutcomes\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePrimary outcome\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe primary outcome was the incidence of EA. Emergence was defined as the time interval from the end of surgery to 2 minutes after tracheal extubation. During emergence, EA was defined as the Riker sedation–agitation scale (RSAS) \u0026gt;4 score, 1 = unarousable, no response to noxious stimuli; 2 = very sedated, arouse to physical stimuli but dose not communicate; 3 = sedated, awakens to verbal commands or gentle shaking but drifts off again; 4 = calm, awakens easily, follows verbal commands; 5 = agitated, anxious or mildly agitated, calms down to verbal instructions; 6 = very agitated, requiring physical restraint and frequent verbal reminding of limits; and 7 = dangerous agitation, pulling at tracheal tube, trying to remove catheters or striking at staff.\u003csup\u003e9\u0026nbsp;\u003c/sup\u003e \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSecondary outcomes\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe secondary outcomes were as follows.\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eThe incidence of severe EA (RSAS = 7) and the maximal RSAS score during emergence were also recorded.\u003c/li\u003e\n \u003cli\u003eRecovery characteristics included extubation time, the length of PACU stay and Maximum NRS score in PACU. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eIntraoperative characteristics included intraoperative\u0026nbsp;sufentanil\u0026nbsp;dosage, duration of surgery, sevoflurane used time ,\u0026nbsp;amount of intraoperative fluid and blood loss.\u003c/li\u003e\n \u003cli\u003eHaemodynamic parameters (including MAP and HR) were recorded at six different time points: T0, T1, T2, T3,T4, and T5.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eThe observation period of postoperative adverse events was from the end of surgery to\u0026nbsp;discharged from the PACU. Postoperative adverse events included hypotension (MAP ≤ 70% of baseline and/or \u0026lt; 65 mmHg), hypertension (MAP\u0026nbsp;≥\u0026nbsp;120% of baseline), bradycardia (HR ≤ 45 beats/min), and tachycardia (HR of\u0026nbsp;≥\u0026nbsp;120% of baseline), \u003csup\u003e10\u003c/sup\u003e postoperative nausea and vomiting (PONV), laryngospasm, cough (Cough level: 0= no coughing; 1= single cough; 2= persistent cough lasting\u0026lt; 5s; 3= persistent cough lasting\u0026nbsp;≥\u0026nbsp;5s) .If these events occurred, intravenous injection of drugs such as ephedrine, urapidil, atropine, esmolol, and tropisetron can be used to\u0026nbsp;treate.\u003c/li\u003e\n \u003cli\u003eThe incidence of\u0026nbsp;postoperative delirium (POD) within 3 days after surgery, which was assessed by Confusion Assessment Method. \u003csup\u003e11\u003c/sup\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSample size and statistical analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 40 patients completed this pre-experiment.\u0026nbsp;According to the results of the\u0026nbsp;pre-experiment,\u0026nbsp;the incidence of EA was 55% in Group C and 25% in Group R. Therefore, a sample size of 76 patients was needed to provide a power of 80% and a significance of 0.05. Considering a 10% attrition rate, we concluded to enroll 86 patients for this study (43 patients in each group).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe data processing and analyses were performed using SPSS 20.0 statistical software\u0026nbsp;(IBM Corp., Armonk, NY, USA). All data are presented as mean ± standard deviation, number (percentage), or median (interquartile range) as appropriate. The normality of distribution was assessed with the Shapiro-Wilk test. Normally distributed data were compared between the groups using an independent-samples t-test, and non-normally distributed data were compared between the groups using the Mann–Whitney U test.\u0026nbsp;Repeated-measures ANOVA\u0026nbsp;was used for intra group comparisons, and\u0026nbsp;Bonferroni Corrections to determine the \u003cem\u003eP\u003c/em\u003e value significance threshold. The chi-square test or Fisher’s exact test was used for comparison of enumeration data between the groups. The significance level for this analysis was set at α = 0.05.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn total, 96 patients were initially screened for eligibility, 2 patients met the exclusion criteria and 8 patients declined to participate in this study. Finally, data for 43 patients in Group R and 43 patients in Group C were analyzed (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003ePatient characteristics and operation details\u003c/h2\u003e\n \u003cp\u003eThe patient baseline characteristics were statistically similar between the two groups (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePatient baseline characteristics\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup R (n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup C (n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge ( years )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.0\u0026thinsp;\u0026plusmn;\u0026thinsp;11.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.732\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeight ( cm )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e168.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e168.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.994\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWeight ( kg )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.194\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex ( Male / Female )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15/28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.235\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASA ( Ⅰ / Ⅱ )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11/32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9/34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.610\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLevel of education, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.644\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;Elementary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eElementary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;Secondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eNotes: Data were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. No statistically significant differences between groups were noted.\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eAbbreviations:\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eASA, American Society of Anesthesiologists.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThere were no significant difference in the incidence of extubation time, the length of PACU stay, NRS for pain, intraoperative sufentanil dosage, duration of surgery, amount of intraoperative fluid and blood loss between the two groups (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eIntra- and Postoperative Characteristics\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup R (n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup C (n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExtubation time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.915\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLength of PACU stay (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.246\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaximum NRS score in PACU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.450\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eType of surgery [ n (%) ]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.892\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSeptoplasty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEthmoidectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBoth Septoplasty and ethmoidectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eType of nasal packing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.747\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuration of surgery (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.6\u0026thinsp;\u0026plusmn;\u0026thinsp;15.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.0\u0026thinsp;\u0026plusmn;\u0026thinsp;13.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.852\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSevoflurane used time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.1\u0026thinsp;\u0026plusmn;\u0026thinsp;15.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.6\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.856\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIntraoperative sufentanil dosage (\u0026micro;g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (28\u0026ndash;30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28 (28\u0026ndash;30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.231\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAmount of intraoperative fluid (ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e529.1\u0026thinsp;\u0026plusmn;\u0026thinsp;148.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e569.5\u0026thinsp;\u0026plusmn;\u0026thinsp;86.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlood loss (ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (10\u0026ndash;25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.477\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eNotes: Data were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, or median (interquartile range). No statistically significant differences between groups were noted.\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eAbbreviations:PACU, post anesthesia care unit. NRS, numeric rating scale.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThe incidence of EA was significantly lower in Group R than in Group C (21% vs 49%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007). The incidence of severe EA was also significantly lower in Group R than in Group C (2% vs 19%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.035). The maximal RSAS score during emergence was significantly lower in Group R (4 [4\u0026ndash;4]) than in Group C (5 [4\u0026ndash;6]), (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eEmergence agitation related outcomes\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup R (n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup C (n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmergence agitation, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(21)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21(49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSevere emergence agitation, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaximal RSAS score during emergence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eNote: Data were presented as median (interquartile range), or number (percentage) as appropriate. *\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, compared with group C.\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eAbbreviations: RSAS, Riker sedation\u0026ndash;agitation scale\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eDuring the emergence period, the hemodynamics of group R showed more stable changes than group C (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eThe incidence of hypertension was significantly lower in Group R than in Group C (5% vs 21%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.024) and grade of cough was significantly lower in Group R (1 [0\u0026ndash;2]) than in Group C (2 [1\u0026ndash;2]) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008). In addition, there were no significant difference in the incidence of hypotension, bradycardia, tachycardia, PONV, laryngospasm and POD between the two groups (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePostoperative Adverse Events\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup R (n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup C (n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypotension, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBradycardia, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.672\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTachycardia, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePONV, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.672\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLaryngospasm, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.494\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade of cough\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(0\u0026ndash;2)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePOD, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eNote: Data were presented as median (IQR) or number (percentage) as appropriate. *\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, compared with group C.\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eAbbreviations:PONV, postoperative nausea and vomiting; POD, postoperative delirium.\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eAbbreviations:HR, heart rate; MAP, mean arterial pressure.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study suggests that intravenous injection of remimazolam at a dose of 0.1 mg/kg at the end of nasal surgery in adult patients can significantly reduce the incidence of EA and severe EA, and also significantly reduce the maximal RSAS score during the emergence. In addition, this intervention can also reduce the incidence of hypertension and grade of cough, thereby presenting a stable hemodynamic.\u003c/p\u003e \u003cp\u003eThe incidence of EA is related to various factors, including pain, endotracheal intubation, inhalation of anesthetics, preoperative anxiety, male gender, age, and type of surgical procedure. Among them, oral surgery and ENT surgery have the highest incidence of EA, with an incidence of 60% and 55.4%, respectively. \u003csup\u003e4\u003c/sup\u003e Previous studies have revealed that the continuous presence of endotracheal intubation during the recovery period causes significant pain in patients, which is the most common cause of EA. \u003csup\u003e12\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eA study showed that intraoperative infusion of dexmedetomidine significantly reduced the incidence of EA in adult patients undergoing nasal surgery (from 52\u0026ndash;28%). \u003csup\u003e13\u003c/sup\u003e The result is similar to that of this study, which decreased from 49\u0026ndash;21%. This may be due to the fact that both dexmedetomidine and remimazolam have the effect of inhibiting patients' rapid awakening, while effectively reducing the intolerable stimulation caused by tracheal intubation and nasal packing. In a recent study by Yang et al., which selected children undergoing tonsillectomy and adenoidectomy under sevoflurane general anesthesia, intravenous administration of 0.2 mg/kg remimazolam at the end of surgery significantly reduced the incidence and severity of emergence delirium. \u003csup\u003e7\u003c/sup\u003e This study is similar to our research results, which show that the use of intravenous remimazolam at the end of surgery can effectively reduce the maximal RSAS score, thereby reducing the incidence of EA and severe EA.\u003c/p\u003e \u003cp\u003eThe clinical manifestation of EA included confusion, disorientation, crying, moaning, shouting, or screaming.\u003csup\u003e14\u003c/sup\u003e These factors may trigger severe fluctuations in hemodynamics, thereby increasing the risk of cardiovascular and cerebrovascular diseases. In this study, Group R showed more stable hemodynamic during the emergence, and the incidence of hypertension and the grade of cough were significantly lower than Group C. Remimazolam has received high attention from many scholars since its launch. Recent studies have shown that remimazolam can not only reduce the incidence of EA during hip replacement surgery in the elderly, but also maintain more stable hemodynamic parameters. \u003csup\u003e15\u003c/sup\u003e In addition, compared with dexmedetomidine, remimazolam is also effective in reducing the incidence of EA in elderly patients after orthopedic surgery. \u003csup\u003e16,17\u003c/sup\u003e The results also showed that there was no significant difference in extubation time and length of PACU stay between the two groups. This may be related to the pharmacological properties of remimazolam, which has been confirmed by multiple studies to have no effect on postoperative recovery time. \u003csup\u003e18,19,20\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAlthough there are several limitations in this study, it is still valuable to explore its results. Firstly, during the experimental process, we only used a single intravenous infusion dose of remimazolam, which was 0.1 mg/kg. Whether this dose is the optimal effective dose remains to be further confirmed by subsequent studies. Secondly, this study is a single-center trial, and it is necessary to conduct multi-center studies in the future to verify the reliability. Despite the above limitations, this study still has important value. Because this study is not only a prospective, double-blind randomized controlled trial; in addition, the subjects were selected from a specific group and standardized anesthesia methods were used, which improved the scientificity and credibility of the research results.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAfter the surgery, the incidence of EA and severe EA in adult nasal surgery can be effectively reduced by intravenous injection of 0.1mg/kg of remimazolam. In addition, the intervention measures will not lead to the extension of extubation time and the length of PACU stay, nor increase the risk of postoperative adverse events. For nasal surgery, this is a safe and effective intervention strategy.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData is provided within the manuscript or supplementary information files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the patients who participated in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTe authors declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis trial was performed in accordance with the Declaration of Helsinki and the Chinese Clinical Trial Specifications. The study was approved by the Medical Ethics Committee of Lishui People's Hospital ( Wenzhou Medical University Lishui Hospital ) (approval No. 2023-137), and was registered in the Chinese Clinical Trial Registry (www.chictr.org.cn; registration number: ChiCTR2300075300, 31/08/2023). Written informed consent was obtained from all participants. The study protocol followed the CONSORT guidelines. The study protocol was performed in the relevant guidelines. \u0026nbsp;\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLepous\u0026eacute; C, Lautner CA, Liu L, et al. Emergence delirium in adults in the post-anaesthesia care unit. Br J Anaesth. 2006;96(6):747\u0026ndash;753. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/bja/ael094\u003c/span\u003e\u003cspan address=\"10.1093/bja/ael094\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMunk L, Andersen G, M\u0026oslash;ller AM. Post-anaesthetic emergence delirium in adults: incidence, predictors and consequences. Acta Anaesthesiol Scand. 2016;60(8):1059\u0026ndash;1066. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/aas.12717\u003c/span\u003e\u003cspan address=\"10.1111/aas.12717\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiang C, Ding M, Du F, Cang J, Xue Z. Sevoflurane/propofol coadministration provides better recovery than sevoflurane in combined general/epidural anesthesia: a randomized clinical trial. J Anesth. 2014;28(5):721\u0026ndash;726. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00540-014-1803-0\u003c/span\u003e\u003cspan address=\"10.1007/s00540-014-1803-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu D, Chai W, Sun X, et al. Emergence agitation in adults: risk factors in 2,000 patients. Can J Anaesth. 2010;57(9):843\u0026ndash;848. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s12630-010-9338-9\u003c/span\u003e\u003cspan address=\"10.1007/s12630-010-9338-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMo JH, Han DH, Shin HW, et al. No packing versus packing after endoscopic sinus surgery: pursuit of patients' comfort after surgery. Am J Rhinol. 2008;22(5):525\u0026ndash;528. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2500/ajr.2008.22.3218\u003c/span\u003e\u003cspan address=\"10.2500/ajr.2008.22.3218\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee A, Shirley M. Remimazolam: A Review in Procedural Sedation. Drugs. 2021;81(10):1193\u0026ndash;1201. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s40265-021-01544-8\u003c/span\u003e\u003cspan address=\"10.1007/s40265-021-01544-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang X, Lin C, Chen S, et al. Remimazolam for the prevention of emergence delirium in children following tonsillectomy and adenoidectomy under sevoflurane anesthesia: a randomized controlled study. Drug Des Devel Ther. 2022;16:3413\u0026ndash;3420. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/DDDT.S381611\u003c/span\u003e\u003cspan address=\"10.2147/DDDT.S381611\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth. 1995;7(1):89\u0026ndash;91. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/0952-8180(94)00001-k\u003c/span\u003e\u003cspan address=\"10.1016/0952-8180(94)00001-k\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee S, Sohn JY, Hwang IE, et al. Effect of a repeated verbal reminder of orientation on emergence agitation after general anaesthesia for minimally invasive abdominal surgery: a randomised controlled trial. Br J Anaesth. 2023;130(4):439\u0026ndash;445. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.bja.2022.12.009\u003c/span\u003e\u003cspan address=\"10.1016/j.bja.2022.12.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmin SM, Hasanin A, ElSayed OS, et al. Comparison of the hemodynamic effects of opioid-based versus lidocaine-based induction of anesthesia with propofol in older adults: a randomized controlled trial. Anaesth Crit Care Pain Med. 2023;42(4):101225. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.accpm.2023.101225\u003c/span\u003e\u003cspan address=\"10.1016/j.accpm.2023.101225\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFlanagan NM, Spencer G. Informal caregivers and detection of delirium in postacute care: a correlational study of the confusion assessment method (CAM), confusion assessment method-family assessment method (CAM-FAM) and DSM-IV criteria. Int J Older People Nurs. 2016;11(3):176\u0026ndash;183. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/opn.12106\u003c/span\u003e\u003cspan address=\"10.1111/opn.12106\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarreto ACTP, Rangel da Rocha Paschoal AC, Barbosa Farias C, et al. Fatores de risco associados a del\u0026iacute;rio no despertar da anestesia em crian\u0026ccedil;as submetidas \u0026agrave; cirurgia ambulatorial [Risk factors associated with anesthesia emergence delirium in children undergoing outpatient surgery]. Braz J Anesthesiol. 2018;68(2):162\u0026ndash;167. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.bjan.2017.11.002\u003c/span\u003e\u003cspan address=\"10.1016/j.bjan.2017.11.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim SY, Kim JM, Lee JH, et al. Efficacy of intraoperative dexmedetomidine infusion on emergence agitation and quality of recovery after nasal surgery. Br J Anaesth. 2013;111(2):222\u0026ndash;228. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/bja/aet056\u003c/span\u003e\u003cspan address=\"10.1093/bja/aet056\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJo JY, Jung KW, Kim HJ, et al. Effect of total intravenous anesthesia vs volatile induction with maintenance anesthesia on emergence agitation after nasal surgery: a randomized clinical trial. JAMA Otolaryngol Head Neck Surg. 2019;145(2):117\u0026ndash;123. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamaoto.2018.3097\u003c/span\u003e\u003cspan address=\"10.1001/jamaoto.2018.3097\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuan J, Ju X, Wang X, et al. Effects of remimazolam and propofol on emergence agitation in elderly patients undergoing hip replacement: a clinical, randomized, controlled study. Drug Des Devel Ther. 2023;17:2669\u0026ndash;2678. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/DDDT.S419146\u003c/span\u003e\u003cspan address=\"10.2147/DDDT.S419146\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeng Y, Qin Z, Wu Q, et al. Efficacy and safety of remimazolam besylate versus dexmedetomidine for sedation in non-Intubated older patients with agitated delirium after orthopedic surgery: a randomized controlled trial. Drug Des Devel Ther. 2022;16:2439\u0026ndash;2451. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/DDDT.S373772\u003c/span\u003e\u003cspan address=\"10.2147/DDDT.S373772\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang JJ, Lei L, Qiu D, et al. Effect of remimazolam on postoperative delirium in older adult patients undergoing orthopedic surgery: a prospective randomized controlled clinical trial. Drug Des Devel Ther. 2023;17:143\u0026ndash;153. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/DDDT.S392569\u003c/span\u003e\u003cspan address=\"10.2147/DDDT.S392569\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee HJ, Lee HB, Kim YJ, et al. Comparison of the recovery profile of remimazolam with flumazenil and propofol anesthesia for open thyroidectomy. BMC Anesthesiol. 2023;23(1):147. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12871-023-02104-1\u003c/span\u003e\u003cspan address=\"10.1186/s12871-023-02104-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKo CC, Hung KC, Illias AM, et al. The use of remimazolam versus propofol for induction and maintenance of general anesthesia: A systematic review and meta-analysis. Front Pharmacol. 2023;14:1101728. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fphar.2023.1101728\u003c/span\u003e\u003cspan address=\"10.3389/fphar.2023.1101728\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiao YQ, Min J, Wu ZX, et al. Comparison of the effects of remimazolam and dexmedetomidine on early postoperative cognitive function in elderly patients with gastric cancer. Front Aging Neurosci. 2023;15:1123089. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fnagi.2023.1123089\u003c/span\u003e\u003cspan address=\"10.3389/fnagi.2023.1123089\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Remimazolam, Nasal surgery, Emergence agitation, General anesthesia ","lastPublishedDoi":"10.21203/rs.3.rs-4270156/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4270156/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe purpose of this study was to evaluate the effectiveness of postoperative use of remimazolam in preventing emergence agitation (EA) in adult following nasal surgery. In total, 86 patients underwent nasal surgery were randomly divided into two groups. Propofol, sufentanil and cis-atracuriumwere used for induction of anaesthesia, then sevoflurane concentration and propofol were used for maintenance of anaesthesia. After surgery, patients were randomly assigned to receive either remimazolam 0.1 mg/kg (Group R, n = 43) or 0.9% normal saline (Group C, n = 43). The outcomes included the incidence of EA, severe EA, extubation time, length of PACU stay and the maximal RSAS score. In this study. The incidence of EA was lower in Group R than in Group C (21% vs 49%, \u003cem\u003eP \u003c/em\u003e= 0.007). The incidence of severe EA was also lower in Group R than in Group C (2% vs 19%, \u003cem\u003eP \u003c/em\u003e= 0.035). The maximal RSAS score during emergence was lower in Group R (4 [4–4]) than in Group C (5 [4–6]) (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). Therefore, postoperative injection of remimazolam 0.1 mg/kginto adult patients underwent nasal surgerycan significantly reduce the incidence of EA and severe EA.\u003c/p\u003e","manuscriptTitle":"Remimazolam for the prevention of emergence agitation in adult following nasal surgery under general anesthesia: A randomized controlled study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-14 17:49:22","doi":"10.21203/rs.3.rs-4270156/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"09224828-e9e6-45aa-ac3a-6c62effc0cca","owner":[],"postedDate":"May 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":31788833,"name":"Biological sciences/Drug discovery"},{"id":31788834,"name":"Biological sciences/Drug discovery/Drug delivery"}],"tags":[],"updatedAt":"2024-07-18T04:54:00+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-14 17:49:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4270156","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4270156","identity":"rs-4270156","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}