Clinical Application Study of Different Doses of Remimazolam Combined With Sevoflurane in Pediatric Adenoidectomy

ImportanceEffective anesthesia with minimal side effects is essential for pediatric patients undergoing adenoidectomy.MethodsA single-center, prospective, randomized controlled trial was conducted at Gaoming District People's Hospital (China, January 2022-October 2023). Two-hundred fifty-six children (ASA I-II, age 3-12 years) scheduled for elective plasma radiofrequency adenoidectomy were randomized to 4 groups (n = 64 each). Group A received 0.9% normal saline; groups B, C, and D received continuous infusions of benzenesulfonate remimazolam at 0.4, 0.6, and 0.8 mg/kg/h, respectively, combined with 6% sevoflurane for induction and 2% to 3% for maintenance. Primary outcomes were emergence time and postanesthesia care unit (PACU) stay. Secondary outcomes included incidence of adverse events, peak Pediatric Anesthesia Emergence Delirium (PAED) scores, and parental satisfaction.ResultsMedian awakening time was longer in groups B, C, and D than in group A (<i>P</i> < .001). PACU stay was shorter in groups C and D versus group A (<i>P</i> < .05). Postoperative pain scores (Face, Legs, Activity, Cry, and Consolability) were lower in groups C and D than in groups A and B (<i>P</i> < .05). Peak PAED scores were lower in groups B, C, and D than in group A (<i>P</i> < .05); negative behavioral changes on postoperative day 3 were also reduced (<i>P</i> < .05). Parental satisfaction was higher in groups B, C, and D than in group A (<i>P</i> < .001). No serious adverse events occurred.Conclusion and RelevanceBenzenesulfonate remimazolam (0.6 mg/kg/h) combined with sevoflurane provides effective, safe anesthesia for pediatric plasma radiofrequency adenoidectomy, balancing induction efficacy, sedation depth, and safety. This regimen reduces emergence delirium, postoperative pain, and negative behavioral changes while enhancing parental satisfaction, supporting its use in pediatric adenoidectomy and warranting further investigation in other pediatric procedures.