Comparison of recovery profiles after anesthesia with remimazolam and flumazenil versus propofol for short-duration gynecological surgery: A prospective, randomized, single-blind trial

Objective: This study aimed to compare the recovery profiles after anesthesia with remimazolam reversed by flumazenil versus propofol among patients undergoing short-duration gynecological surgeries. Methods: In this prospective, single-blind, randomized trial, 86 patients were assigned to either the propofol group (n = 43, received propofol and remifentanil) or the remimazolam group (n = 43, received remimazolam and remifentanil). At the end of the surgery, patients in the propofol group received 2 mg/kg sugammadex, whereas those in the remimazolam group received 2 mg/kg sugammadex combined with 200 μg flumazenil. Recovery was measured across immediate, intermediate, and long-term phases. Results: Eye-opening and extubation times were significantly shorter in the remimazolam group (p < .001). However, the the postanesthetic care unit stay times were significantly longer in this group due to institutional safety protocols (p < .001). No statistical differences were found in the Quality of Recovery-15 K scores or other long-term recovery profiles at 4 h or 1 day postoperatively. Conclusions: Remimazolam–flumazenil significantly improved immediate recovery; however, its effects on the broader recovery trajectory were not significantly different from those of propofol, the most commonly used drug. Although Quality of Recovery-15 K scores were numerically higher in the remimazolam group, the difference was not statistically significant. Trial registration: Clinical Research Information Service (CRIS), KCT0008314.