Does Propofol-based or Remimazolam-based Anesthesia Impact the Incidence of Postoperative Nausea and Vomiting When Used In Combination With Prophylactic Dexamethasone and Ondansetron?

[OBJECTIVE] This study aimed to compare the incidence of postoperative nausea and vomiting (PONV) between propofol-based and remimazolam-based anesthesia in combination with dexamethasone and ondansetron.

[METHODS] Subjects were 20 to 50 years of age with a preoperative American Society of Anesthesiologists physical status classification I or II scheduled for bilateral sagittal split ramus osteotomy and genioplasty. General anesthesia was induced and maintained using propofol or remimazolam, and dexamethasone (6.6 mg) was administered after intubation. Ondansetron (4 mg) was administered intravenously 15 minutes before the end of surgery. Incidence of PONV was assessed overall and at 3 periods within the first 24 hours after anesthesia. Severity of PONV was assessed using a numerical rating scale (NRS), and quality of recovery was also assessed. Intravenous metoclopramide (10 mg) was administered for rescue in those with an NRS score greater than 4.

[RESULTS] A total of 100 subjects participated in this study and had an incidence of overall PONV that was higher with remimazolam (18%) than with propofol (6%) but lacked significance (P = .12). There were no significant differences in PONV at any of the periods, nor in mean NRS scores, quality of recovery, or metoclopramide use.

[CONCLUSION] The incidence of PONV during 24 hours after orthognathic surgery was not significantly different when using remimazolam-based anesthesia vs propofol-based anesthesia in combination with dexamethasone and ondansetron. There were also no significant differences in the severity of PONV or the quality of recovery between the 2 groups.