Quality of recovery after arthroscopic meniscectomy with remimazolam or propofol anesthesia: A randomized controlled trial

BACKGROUND: Anesthetic technique may influence postoperative quality of recovery (QoR). Remimazolam may offer hemodynamic stability and favorable early recovery characteristics, but its effect on patient-reported QoR compared with propofol remains unclear. This is particularly relevant in minor orthopedic surgery, where QoR is a principal outcome. This randomized controlled trial compared postoperative QoR between propofol-based and remimazolam-based total intravenous anesthesia (TIVA) using the QoR-40 questionnaire. MATERIALS AND METHODS: Eighty adult patients undergoing elective arthroscopic meniscectomy were randomly assigned to propofol-based or remimazolam-based TIVA; 71 patients completed the QoR-40 questionnaire and were included in the final analysis (36 in the Propofol group, 35 in the Remimazolam group). The primary outcome was the global QoR-40 score on postoperative day (POD) 1. Secondary outcomes included intraoperative hemodynamic variables, anesthetic and analgesic requirements, postoperative recovery profiles, pain scores, and postoperative nausea and vomiting. RESULTS: Global QoR-40 scores on POD 1 did not differ significantly between the Propofol and Remimazolam groups (166.1 ± 16.8 vs. 170.6 ± 13.6; mean difference -4.5, 95% CI -11.8 to 2.7; P = 0.218). In an exploratory analysis, the emotional-state domain scores were higher in the Remimazolam group (37.0 ± 4.3 vs. 39.2 ± 2.5; mean difference -2.2, 95% CI -3.9 to -0.6; P = 0.009). The Remimazolam group had a longer time to full alertness (18 [15-24] vs. 37 [31-45] min; P < 0.001) and longer post-anesthesia care unit stay (30 [30-39] vs. 38 [30-50] min; P = 0.008). Intraoperative hypotension requiring ephedrine occurred more frequently in the Propofol group (44.4% vs. 17.1%; P = 0.013). CONCLUSIONS: Global QoR-40 scores on POD 1 did not differ significantly between propofol-based and remimazolam-based TIVA in adults undergoing elective arthroscopic meniscectomy, although remimazolam was associated with greater intraoperative hemodynamic stability at the cost of slower return to full alertness.