A large meta-analysis found that the comparison anesthetic and the chosen emesis outcome changed the interpretation.
Fifty randomized trials involving 9,193 participants showed no significant overall difference in postoperative nausea and vomiting between remimazolam and pooled alternative agents. Subgroups favored remimazolam against inhaled anesthetics, while postoperative vomiting was more frequent than with propofol. Overall nausea-and-vomiting and vomiting-only endpoints were distinct.
The trials differed in patients, prevention regimens, timing, dosing, and flumazenil use. Subgroup findings require caution, and pooled agents do not form a single uniform comparator. A statistically nonsignificant overall result does not erase clinically relevant differences between regimens.
A report should state the actual comparator and endpoint before claiming an antiemetic advantage. For a patient with postoperative symptoms, review baseline susceptibility, opioids, other anesthetics, prophylaxis, and timing. This synthesis cannot isolate the cause of a particular episode of nausea or vomiting.
Source reviewed: Efficacy of remimazolam in preventing postoperative nausea and vomiting a systematic review and meta (PMC12336335). This article summarizes the supplied paper; forensic applications above are interpretive analysis.
Related reading: UK–Norway Rescue-Medication Survey Found Different Training and Review Practices; Remimazolam Endoscopy Induction Success Was Different From Completion Success.