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已发表论文
老年日间手术患者术后恢复质量：瑞马唑仑与依托咪酯用于麻醉诱导的随机非劣效性试验
Authors Liu J, Hu S, Zhang E, Zhang P, Guo X, Zheng Z, Fu J, Nie H
Received 4 July 2025
Accepted for publication 7 November 2025
Published 14 November 2025 Volume 2025:20 Pages 1993—2004
DOI https://doi.org/10.2147/CIA.S551569
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Zhi-Ying Wu
Jia Liu,1,2 Sheng Hu,3 Erfei Zhang,4 Pan Zhang,4 Xiaowei Guo,3 Ziyu Zheng,1,2 Jingwen Fu,1,2 Huang Nie1,2
1Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, People’s Republic of China; 2Key Laboratory of Anesthesiology (The Fourth Military Medical University), Ministry of Education, Xi’an, Shaanxi, People’s Republic of China; 3Department of Anesthesiology and Perioperative Medicine, Xi’an People’s Hospital (Xi’an Fourth Hospital), Northwest University, Xi’an, Shaanxi, People’s Republic of China; 4Department of Anesthesiology and Perioperative Medicine, Affiliated Hospital of Yan’an University, Yan’an, Shaanxi, People’s Republic of China
Correspondence: Huang Nie, Department of Anesthesiology and Perioperative Medicine, Fourth Military Medical University Xijing Hospital, Xi’an, People’s Republic of China, Tel +8613201630298, Email niehuang@163.com
Introduction: This study compared the quality of postoperative recovery among older patients undergoing day surgery with induction using remimazolam or etomidate.
Methods: This multicenter, randomized, parallel-group, double-blinded trial with a non-inferiority design was conducted in three tertiary university hospitals. Older patients undergoing day surgery were randomly assigned to receive either remimazolam or etomidate for pump-induced general anesthesia. The primary outcome was the 15-item Quality of Recovery (QoR-15) score on postoperative day 1 (POD1). The mean difference between the groups was compared against a non-inferiority margin of − 8. Secondary outcomes included the QoR-15 score on POD2, scores for the five QoR-15 dimensions, and vital signs at predefined time points.
Results: In total, 118 older patients were randomized to the two groups. In the per-protocol set, the QoR-15 score on POD1 was 133.7 ± 12.9 in the remimazolam group, versus 131.2 ± 17.3 in the etomidate group, with a mean difference of 2.5 [95% confidence interval [CI]: − 3.2, 8.2). In the modified intention-to-treat set, the QoR-15 scores were 133.5 ± 12.9 and 131.2 ± 17.6 in the remimazolam and etomidate groups, respectively, with a mean difference of 2.3 (95% CI: − 3.3, 7.8). The lower limit of the confidence interval exceeded the predefined non-inferiority cutoff of − 8, confirming the non-inferiority of remimazolam (P < 0.001). We compared the QoR-15 dimension scores on POD1 with the baseline scores in both groups. In the remimazolam group, only the physical independence score on POD1 was higher than at baseline, whereas in the etomidate group, the total QoR-15, physical comfort, physical independence, and emotional state scores were all lower on POD1 than at baseline. During anesthesia maintenance, the remifentanil dosage was higher in the remimazolam group than in the etomidate group (890.1 ± 5.7 μg vs 745.1 ± 45.3 μg, P = 0.037).
Conclusion: In older patients undergoing day surgery, remimazolam exhibited non-inferiority to etomidate for anesthesia induction in terms of QoR-15 scores on POD1.
Keywords: remimazolam, etomidate, older patients, postoperative recovery quality, day surgery
1Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, People’s Republic of China; 2Key Laboratory of Anesthesiology (The Fourth Military Medical University), Ministry of Education, Xi’an, Shaanxi, People’s Republic of China; 3Department of Anesthesiology and Perioperative Medicine, Xi’an People’s Hospital (Xi’an Fourth Hospital), Northwest University, Xi’an, Shaanxi, People’s Republic of China; 4Department of Anesthesiology and Perioperative Medicine, Affiliated Hospital of Yan’an University, Yan’an, Shaanxi, People’s Republic of China
Correspondence: Huang Nie, Department of Anesthesiology and Perioperative Medicine, Fourth Military Medical University Xijing Hospital, Xi’an, People’s Republic of China, Tel +8613201630298, Email niehuang@163.com
Introduction: This study compared the quality of postoperative recovery among older patients undergoing day surgery with induction using remimazolam or etomidate.
Methods: This multicenter, randomized, parallel-group, double-blinded trial with a non-inferiority design was conducted in three tertiary university hospitals. Older patients undergoing day surgery were randomly assigned to receive either remimazolam or etomidate for pump-induced general anesthesia. The primary outcome was the 15-item Quality of Recovery (QoR-15) score on postoperative day 1 (POD1). The mean difference between the groups was compared against a non-inferiority margin of − 8. Secondary outcomes included the QoR-15 score on POD2, scores for the five QoR-15 dimensions, and vital signs at predefined time points.
Results: In total, 118 older patients were randomized to the two groups. In the per-protocol set, the QoR-15 score on POD1 was 133.7 ± 12.9 in the remimazolam group, versus 131.2 ± 17.3 in the etomidate group, with a mean difference of 2.5 [95% confidence interval [CI]: − 3.2, 8.2). In the modified intention-to-treat set, the QoR-15 scores were 133.5 ± 12.9 and 131.2 ± 17.6 in the remimazolam and etomidate groups, respectively, with a mean difference of 2.3 (95% CI: − 3.3, 7.8). The lower limit of the confidence interval exceeded the predefined non-inferiority cutoff of − 8, confirming the non-inferiority of remimazolam (P < 0.001). We compared the QoR-15 dimension scores on POD1 with the baseline scores in both groups. In the remimazolam group, only the physical independence score on POD1 was higher than at baseline, whereas in the etomidate group, the total QoR-15, physical comfort, physical independence, and emotional state scores were all lower on POD1 than at baseline. During anesthesia maintenance, the remifentanil dosage was higher in the remimazolam group than in the etomidate group (890.1 ± 5.7 μg vs 745.1 ± 45.3 μg, P = 0.037).
Conclusion: In older patients undergoing day surgery, remimazolam exhibited non-inferiority to etomidate for anesthesia induction in terms of QoR-15 scores on POD1.
Keywords: remimazolam, etomidate, older patients, postoperative recovery quality, day surgery