Comparative study on the impact of remimazolam and sevoflurane on quality of recovery after transurethral resection of bladder tumor A randomized controlled noninferiority study

Background: Remimazolam is manifested by rapid action, hemodynamic stability, and fast recovery. Our study aimed to investigate whether the quality of recovery (QoR) after remimazolam anesthesia in patients undergoing transurethral resection of bladder tumor, which is predominantly performed in the elderly population, is not inferior to that after conventional anesthesia using sevoflurane. Methods: Thirty-four patients were randomly allocated into either of group S (n = 17, receiving sevoflurane anesthesia), or group R (n = 17, receiving remimazolam anesthesia). The QoR was assessed by Korean version of QoR-15 questionnaire, on the day before and after the surgery. Scores acquired for each individual item, QoR-15 scores categorized into 5 dimensions (physical comfort, physical independence, psychological support, emotional state, and pain), and overall global score were subjected to comparative analysis. The primary outcome was postoperative global QoR-15, and a noninferiority delta value of 8.0 was employed. Results: The postoperative global QoR-15 in the group S was 141 (134–146), and in the groups R was 133 (128–142) (P = .152). The mean difference of global QoR-15 (group S–group R) was 1.471 (95% confidence interval of −10.204 to 13.146), and the lower 95% confidence interval margin was lower than the noninferiority margin of −8.0. When comparing the QoR-15 sorted by 5 dimensions, pain scored higher in the group S (20 [18–20]) compared to the group R (15 [15–20], P = .032). Conclusion: The postoperative QoR following transurethral resection of bladder tumor was found to be lower in patients anesthetized with remimazolam in comparison to those anesthetized with sevoflurane.