Effects of remimazolam on postanesthetic shivering and related clinical responses in patients undergoing cesarean section

Purpose This study aimed to evaluate the association between remimazolam administration and perioperative shivering as well as related clinical outcomes in patients undergoing cesarean section under neuraxial anesthesia. Methods A total of 120 patients undergoing cesarean section under neuraxial anesthesia were randomly allocated to a remimazolam group (R), a remimazolam plus flumazenil group (RF), or a normal saline group (C) ( n = 40 each). In the R group, remimazolam was administered intravenously at 0.1 mg/kg after fetal delivery, followed by continuous infusion at 0.2 mg/kg/h until the end of surgery. In the RF group, flumazenil was administered at the end of surgery to reverse sedation. The C group received an equivalent volume of normal saline. The incidence and severity of perioperative shivering, changes in perioperative body temperature, intraoperative traction response scores, and perioperative adverse events were compared among the three groups. Results The incidence of perioperative shivering was 17.5% in the R group and 30.0% in the RF group, both of which were significantly lower than that in the C group (52.5%; p < 0.05). Intraoperative and postoperative body temperatures were higher in the R group than in the C group ( p < 0.05). During uterine cavity manipulation, traction response scores were lower in the R and RF groups than in the C group ( p < 0.05). The incidence of postoperative nausea and vomiting was lower in the R and RF groups than in the C group ( p < 0.05). Conclusion In patients undergoing cesarean section under neuraxial anesthesia, remimazolam administration after fetal delivery was associated with a lower incidence of perioperative shivering, higher perioperative body temperature, and reduced intraoperative traction responses. Differences in perioperative adverse events were observed among the groups. The reduction in perioperative shivering was partially preserved after reversal with flumazenil.