Authors: Yun Liu et al
BMC Anesthesiology, 2025; Article 483. Volume 25, 2025
This randomized, double-blind clinical trial compared remimazolam and dexmedetomidine for postoperative sedation following free-flap reconstruction in patients with oral tumors—a surgical population requiring stable hemodynamics and smooth emergence to protect delicate microvascular anastomoses. Although dexmedetomidine is widely used for sedation, remimazolam’s rapid offset and limited cardiovascular depression present potential advantages.
Sixty patients were enrolled between September 2021 and November 2022, with 57 completing the study (29 receiving remimazolam and 28 dexmedetomidine). Upon PACU admission, each patient received continuous infusion of either remimazolam (0.25 mg/kg/h) or dexmedetomidine (0.4 μg/kg/h), titrated to a Ramsay sedation score of 2–3. The primary outcome was the incidence of emergence agitation, defined as a Richmond Agitation-Sedation Scale (RASS) score of +2 or greater. Secondary outcomes included postoperative delirium, pain, nausea, vomiting, sleep quality, hospital stay, and complications.
Both sedatives achieved similar control of emergence agitation, with no significant difference between groups (27.6% vs. 25.0%, p > 0.999). Secondary outcomes were likewise comparable across all measured variables. However, remimazolam was associated with a significantly lower requirement for colloid administration in the PACU (3.4% vs. 32.1%, p = 0.005), suggesting better hemodynamic stability.
These results demonstrate that remimazolam provides sedation equivalent to dexmedetomidine in efficacy and safety but with the added benefit of improved circulatory stability and reduced volume resuscitation needs. Given its short half-life and minimal cardiovascular impact, remimazolam represents a promising alternative for postoperative sedation following complex head and neck free-flap surgery.
What You Should Know
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Remimazolam and dexmedetomidine were equally effective in preventing emergence agitation after free-flap reconstruction.
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Remimazolam reduced colloid use, indicating greater hemodynamic stability.
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No significant differences were observed in pain, delirium, or hospital stay.
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Remimazolam’s rapid offset and stability make it a practical option for microvascular surgical sedation.
Thank you to BMC Anesthesiology for publishing this clinical comparison supporting remimazolam as a hemodynamically favorable alternative to dexmedetomidine in postoperative microvascular sedation.