Comparison of Postoperative Nausea and Vomiting Between Sedation with Remimazolam and Dexmedetomidine in Transcatheter Aortic Valve Replacement Patients: A Single-Center Retrospective Observational Study

<b>Background/Objectives</b>: Remimazolam, a short-acting benzodiazepine, promotes quick and consistent recovery from anesthesia. However, flumazenil's rapid antagonistic effects on benzodiazepines during the emergence from anesthesia are thought to increase the risk of postoperative nausea and vomiting (PONV). This study aimed to compare the rate of PONV in monitored anesthesia care (MAC) with remimazolam versus conventional MAC with dexmedetomidine. <b>Methods</b>: This single-center retrospective study included all cases with transcatheter aortic valve replacements (TAVR) performed using MAC at our institution between January 2019 and April 2023. The patients were divided into remimazolam and dexmedetomidine-propofol groups based on the anesthetic method used. We used propensity score matching at a 1:1 ratio to account for the patient backgrounds. The primary outcome measure was the rate of PONV within 48 h. Secondary outcome measures included the severity of PONV and the number of antiemetics administered. <b>Results</b>: This study included 177 subjects. Following propensity score matching, 61 patients were allocated to each group. The incidence of PONV within 48 h after surgery was 4.92% in the remimazolam group and 3.28% in the dexmedetomidine-propofol group, with no significant difference between the two groups (<i>p</i> = 0.817). There was no significant difference between the two groups in terms of the secondary outcomes, including the severity of PONV (<i>p</i> = 0.190) and the use of antiemetics (<i>p</i> = 0.690). <b>Conclusions</b>: In TAVR with MAC and remimazolam, the incidence of PONV within 48 h was comparable to that of dexmedetomidine.