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2026, Vol: 10, Issue: 9
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Review Article
Online Published: 20 Oct 2026
 


Perioperative remimazolam for prevention of emergence agitation after nasal surgery in adults: a meta-analysis of randomized controlled trials

Ghadah Alanazi, Maysam Alamri, Dalaa Alshahrani, Lama Almutairi, Jawad Muqayyim, Raneem Alghanmi, Lamyaa Albaqami, Sarah Alatawi, Lamis Alshehri, Khalid Althubyani, Hassan Moria.


Abstract
Emergence agitation (EA) is common after nasal surgery and might lead to self-injury, bleeding, and hemodynamic instability. Remimazolam is an ultra-short-acting benzodiazepine that provides rapid, reversible recovery and might reduce the risk of E.A. However, individual trials have been small. This meta-analysis evaluated the effect of perioperative remimazolam on EA and related outcomes in adults undergoing nasal or rhinologic surgery. PubMed, Scopus, Web of Science, and the Cochrane Library were searched from inception to March 2026 for parallel-group randomized controlled trials in adults undergoing nasal or rhinologic surgery, in which at least one arm received peri-operative remimazolam. The primary outcome was the incidence of EA dichotomous outcomes being pooled as risk ratios (RR) and continuous outcomes as mean differences (MD) using random-effects models. Risk of bias (RoB 2), GRADE, and trial sequential analysis (TSA) were applied. Five trials (421 patients) were included. Remimazolam significantly reduced EA (RR 0.47, 95% CI 0.35 to 0.62; I²=18%) and severe EA (RR 0.26, 95% CI 0.14 to 0.48; I²=0%). TSA crossed the monitoring boundary for benefit. Time to extubation (MD 0.33 min) and post-operative pain (MD -0.22) did not differ. Hypotension was less frequent with remimazolam (RR 0.35, 95% CI 0.18 to 0.66), with no increase in PONV, laryngospasm, bleeding, or bradycardia. Perioperative remimazolam reduced the incidence and severity of emergence-agitation after nasal surgery without delaying recovery or increasing adverse events. The certainty of evidence was moderate for agitation outcomes and lower for recovery and safety outcomes.

Key words: Remimazolam, emergence agitation, nasal surgery, general anesthesia, meta-analysis


 
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How to Cite this Article
Pubmed Style

Alanazi G, Alamri M, Alshahrani D, Almutairi L, Muqayyim J, Alghanmi R, Albaqami L, Alatawi S, Alshehri L, Althubyani K, Moria H. Perioperative remimazolam for prevention of emergence agitation after nasal surgery in adults: a meta-analysis of randomized controlled trials. IJMDC. Online First: 20 Oct, 2026. doi:10.24911/IJMDC.51-1788526270

Web Style

Alanazi G, Alamri M, Alshahrani D, Almutairi L, Muqayyim J, Alghanmi R, Albaqami L, Alatawi S, Alshehri L, Althubyani K, Moria H. Perioperative remimazolam for prevention of emergence agitation after nasal surgery in adults: a meta-analysis of randomized controlled trials. https://www.ijmdc.com/?mno=333616 [Access: October 20, 2026]. doi:10.24911/IJMDC.51-1788526270

AMA (American Medical Association) Style

Alanazi G, Alamri M, Alshahrani D, Almutairi L, Muqayyim J, Alghanmi R, Albaqami L, Alatawi S, Alshehri L, Althubyani K, Moria H. Perioperative remimazolam for prevention of emergence agitation after nasal surgery in adults: a meta-analysis of randomized controlled trials. IJMDC. Online First: 20 Oct, 2026. doi:10.24911/IJMDC.51-1788526270


Vancouver/ICMJE Style

Alanazi G, Alamri M, Alshahrani D, Almutairi L, Muqayyim J, Alghanmi R, Albaqami L, Alatawi S, Alshehri L, Althubyani K, Moria H. Perioperative remimazolam for prevention of emergence agitation after nasal surgery in adults: a meta-analysis of randomized controlled trials. IJMDC, [cited October 20, 2026]; Online First: 20 Oct, 2026. doi:10.24911/IJMDC.51-1788526270


Harvard Style

Alanazi, G., Alamri, . M., Alshahrani, . D., Almutairi, . L., Muqayyim, . J., Alghanmi, . R., Albaqami, . L., Alatawi, . S., Alshehri, . L., Althubyani, . K. & Moria, . H. (2026) Perioperative remimazolam for prevention of emergence agitation after nasal surgery in adults: a meta-analysis of randomized controlled trials. IJMDC, Online First: 20 Oct, 2026. doi:10.24911/IJMDC.51-1788526270


Turabian Style

Alanazi, Ghadah, Maysam Alamri, Dalaa Alshahrani, Lama Almutairi, Jawad Muqayyim, Raneem Alghanmi, Lamyaa Albaqami, Sarah Alatawi, Lamis Alshehri, Khalid Althubyani, and Hassan Moria. 2026. Perioperative remimazolam for prevention of emergence agitation after nasal surgery in adults: a meta-analysis of randomized controlled trials. International Journal of Medicine in Developing Countries, Online First: 20 Oct, 2026. doi:10.24911/IJMDC.51-1788526270


Chicago Style

Alanazi, Ghadah, Maysam Alamri, Dalaa Alshahrani, Lama Almutairi, Jawad Muqayyim, Raneem Alghanmi, Lamyaa Albaqami, Sarah Alatawi, Lamis Alshehri, Khalid Althubyani, and Hassan Moria. "Perioperative remimazolam for prevention of emergence agitation after nasal surgery in adults: a meta-analysis of randomized controlled trials." International Journal of Medicine in Developing Countries Online First: 20 Oct, 2026. doi:10.24911/IJMDC.51-1788526270


MLA (The Modern Language Association) Style

Alanazi, Ghadah, Maysam Alamri, Dalaa Alshahrani, Lama Almutairi, Jawad Muqayyim, Raneem Alghanmi, Lamyaa Albaqami, Sarah Alatawi, Lamis Alshehri, Khalid Althubyani, and Hassan Moria. "Perioperative remimazolam for prevention of emergence agitation after nasal surgery in adults: a meta-analysis of randomized controlled trials." International Journal of Medicine in Developing Countries Online First: 20 Oct, 2026. Web. 20 Oct 2026 doi:10.24911/IJMDC.51-1788526270


APA (American Psychological Association) Style

Alanazi, G., Alamri, . M., Alshahrani, . D., Almutairi, . L., Muqayyim, . J., Alghanmi, . R., Albaqami, . L., Alatawi, . S., Alshehri, . L., Althubyani, . K. & Moria, . H. (2026) Perioperative remimazolam for prevention of emergence agitation after nasal surgery in adults: a meta-analysis of randomized controlled trials. International Journal of Medicine in Developing Countries, Online First: 20 Oct, 2026. doi:10.24911/IJMDC.51-1788526270




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