Prevention of Postoperative Nausea and Vomiting After Gynaecological day Surgery Under Remimazolam General Anesthesia

A Randomized Double-blind Controlled Study

Fuxia Yi; Hongyi Xiao; Teng Zhu; Yan Man; Fanceng Ji


BMC Anesthesiol. 2022;22(292) 

In This Article

Abstract and Introduction


Purpose: To observe the effect of different antiemetic drugs for the prevention of postoperative nausea and vomiting (PONV) after gynaecological day surgery under remimazolam general anesthesia.

Methods: One hundred ninety-two patients were selected for gynaecological day surgery and randomly divided into three groups: droperidol group (DD group), tropisetron group (DT group) and control group (DC group). Flurbiprofen axetil 50 mg and dexamethasone 5 mg were given intravenously before induction of anesthesia, and 2 min later droperidol 1 mg was given intravenously to the DD group, tropisetron 5 mg to the DT group and saline (5 ml) to the DC group. Induction of anesthesia: remimazolam 6 mg/kg/h was continuously infused until sleep, mivacurium 0.2 mg/kg and alfentanil 20ug/kg were slowly pushed, 3 min later intubation was performed to control breathing. Maintenance of anesthesia: 40ug/kg/h of alfentanil, 1 mg/kg/h of remimazolam continuous infusion. After awakening and extubation, the patient was transferred to the PACU. PONV were recorded in the PACU and an electronic questionnaire was pushed 24 h after surgery.

Results: The incidence of PONV within the PACU was significantly lower in the DD (14.5%)and DT(26.7%) groups than in the DC(50%) group (p < 0.01), there was no significantly difference between the DT and DD groups. There were no significant difference in the incidence of PONV in 24 h after surgery between the three groups(DD:DT:DC = 44.5%:45.1%:63.8%,p > 0.05).

Conclusions: Droperidol or tropisetron combined with dexamethasone is superior to dexamethasone alone for the prevention of PONV in the PACU after remimazolam combined with alfentanil anesthesia, with no significant difference in the incidence of PONV in 24 h after surgery.


Postoperative nausea and vomiting (PONV) is one of the most common complications of general anesthesia.[1] The risk factors of PONV include the patient-related factors, anesthetic factors and surgical factors. Gynecological day surgery patients are at high risk for PONV in terms of gender, age, motion sickness, gynecological surgery and opioids, with PONV being as high as 80% in high-risk patients.

Remimazolam is a novel benzodiazepine that acts on central GABAA receptors to produce sedation and amnesia and is widely used for preoperative administration, endoscopic anesthesia, induction maintenance of general anesthesia and in ICU administrations.[2] Alfentanil is a short-acting opioid with low respiratory depression, less cough induced and fast metabolism, which is suitable for daytime surgical anesthesia. The combination of different types of antiemetic drugs is better than single drugs for prevention and treatment, and reduces side effects.[3] 5-HT3 receptor inhibitors, dexamethasone and droperidol are commonly used for the prevention of PONV. Whether the combination of the above drugs is effective in preventing PONV after remimazolam combined with alfentanil total intravenous anesthesia deserves clinical investigation.