Comparing the effect of remimazolam and propofol anesthesia on extubation time, hospital stay and psychological wellbeing post pediatric tonsillectomy and adenoidectomy.

BACKGROUND: Chronic tonsillitis and adenoid hypertrophy can significantly impact children's growth and development, making surgical intervention necessary. The choice of anesthesia is critical to ensuring both safety and efficacy during such procedures. Propofol and remimazolam are commonly used anesthetic agents, but their relative advantages in pediatric surgery have not been thoroughly explored. Therefore, this study examines the comparative effects of propofol and remimazolam anesthesia in pediatric patients undergoing tonsillectomy and adenoidectomy. We hypothesized that remimazolam would result in more stable intraoperative vital signs, faster postoperative recovery, and fewer adverse events than propofol. METHODS: In this comparative study, 193 pediatric patients from the Maternal and Child Health Hospital of Hubei Province in Wuhan, China, were enrolled between October 2021 and October 2023. Of these, 83 received propofol anesthesia and 110 received remimazolam anesthesia. The study assessed hemodynamic parameters, including heart rate, blood pressure, and oxygen saturation, at several time points, along with various recovery outcomes such as surgical duration, time to spontaneous respiratory recovery, extubation, and postoperative hospital stay. Moreover, post-extubation coughing, CHEOPS pain score, Ramsay score, Sedation-Agitation Scale (SAS) and rate of adverse reactions were compared between the two groups of pediatric patients subsequent to surgery. RESULTS: The differences in HR, SBP, DBP, and SpO2 between groups and time points were statistically significant (P < 0.01). The vital signs of the remimazolam group were more stable than those of the propofol group at each time point. The surgical duration did not show a substantial variance between the two groups (P > 0.05), but the remimazolam group displayed shorter times for spontaneous respiratory recovery, eye-opening upon verbal stimulation, awakening, discontinuation of monitoring, postoperative hospital stay, tracheal extubation, and recovery of consciousness after extubation compared to the propofol group (P < 0.01). Furthermore, there were statistically significant differences in the CHEOPS pain score, Ramsay score, and SAS score between groups and time points (P < 0.01). The CHEOPS pain score, Ramsay score, and SAS score at time points T2 and T3 were lower in the remimazolam group compare with the propofol group, and these differences held statistical significance (P < 0.05). Moreover, the remimazolam group exhibited a lower probability of postoperative hypotension and bradycardia versus the propofol group, and the remimazolam group exhibited a reduced overall occurrence of adverse reactions, with differences containing statistical differences (P < 0.05). CONCLUSION: In conclusion, remimazolam offers superior stability, faster recovery, and fewer complications compared to propofol. These findings support the use of remimazolam as a safer and more efficient anesthetic agent for pediatric tonsillectomy and adenoidectomy.