Alfentanil-remimazolam shortens emergence time versus fentanyl-remimazolam in first-trimester abortion anesthesia
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Key Takeaway
Consider alfentanil-remimazolam's shorter emergence time for brief procedures, but evidence is preliminary.
This randomized controlled trial compared two intravenous anesthetic regimens in 120 patients undergoing first-trimester surgical abortion (vacuum aspiration) in a hospital setting. The intervention was alfentanil (10 μg kg⁻¹) combined with remimazolam (0.3 mg kg⁻¹) (AF-RMZ), compared to fentanyl (1 μg kg⁻¹) combined with remimazolam (0.3 mg kg⁻¹) (F-RMZ). The primary outcome was emergence time from anesthesia.
The main results indicated shorter times for the AF-RMZ group. Emergence time was 68.40 ± 47.01 seconds for AF-RMZ versus an unreported time for F-RMZ. Induction time was 37.97 ± 4.38 seconds for AF-RMZ, and discharge time was reduced to 36.38 ± 5.31 minutes. Total remimazolam use and postoperative Visual Analog Scale pain scores at 30 minutes were similar between groups. Peripheral oxygen saturation was transiently higher in the F-RMZ group at early time points, while mean arterial pressure remained comparable.
Adverse events were reported as mild, though specific rates for events like low SpO₂, bradycardia, hypotension, somatomotor response, and postoperative nausea and vomiting were not detailed. Key limitations include the lack of reported p-values or confidence intervals for the time comparisons, making the statistical significance of the differences unclear. The follow-up duration was also not reported. For practice, the observed shorter emergence and discharge times with AF-RMZ suggest a potential workflow advantage in brief outpatient procedures, but the evidence is preliminary and requires replication with full statistical reporting.
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View Original Abstract ↓
BackgroundAlfentanil is a short-acting μ-opioid receptor agonist that can be used synergistically with other sedatives. This study aimed to investigate the clinical efficacy of an alfentanil-remimazolam combination for first-trimester surgical abortion (vacuum aspiration) under intravenous anesthesia.MethodsA total of 120 patients undergoing first-trimester surgical abortion under intravenous anesthesia at our hospital were recruited between January 1, 2025 and June 30, 2025, and were randomly assigned to two groups: the alfentanil-remimazolam group (AF-RMZ, n = 60) and the fentanyl-remimazolam group (F-RMZ, n = 60). The AF-RMZ group received alfentanil (10 μg kg−1) combined with remimazolam (0.3 mg kg−1), while the F-RMZ group received fentanyl (1 μg kg−1) combined with remimazolam (0.3 mg kg−1). The primary outcome was emergence time from anesthesia. Secondary outcomes included intravenous anesthesia induction time, total remimazolam dose, Visual Analog Scale (VAS) score at 30 min after awakening, and adverse events, including low pulse oximetry (SpO₂), bradycardia, hypotension, somatomotor response, and postoperative nausea and vomiting (PONV).ResultsThe AF-RMZ and F-RMZ groups had comparable demographic characteristics. AF-RMZ showed shorter induction (37.97 ± 4.38 s) and emergence times (68.40 ± 47.01 s) and reduced discharge time (36.38 ± 5.31 min) compared with F-RMZ, while total remimazolam use and postoperative 30-min VAS scores were similar. Heart rate and respiratory rate exhibited significant group-time interactions, whereas mean arterial pressure remained comparable. Peripheral oxygen saturation was transiently higher in the F-RMZ at early time points. All SpO₂ values remained clinically acceptable, supporting monitored respiratory safety. Adverse events were mild, with a lower incidence of somatomotor response in AF-RMZ (8.3% vs. 21.7%, p = 0.036).ConclusionAlfentanil combined with remimazolam showed a slight advantage in anesthesia induction and emergence times, with comparable postoperative recovery, clinically stable hemodynamics, and safety profiles compared with fentanyl–remimazolam in outpatient gynecological procedures; however, the clinical impact of these differences may be limited.Clinical trial registrationhttps://www.chictr.org.cn, identifier ChiCTR2400094571.
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