Comparison of remimazolam and propofol in anesthetic management for awake craniotomy: a retrospective study.

A new ultra-short-acting benzodiazepine intravenous anesthetic agent, remimazolam, was launched in Japan in 2020. Anesthesia during awake craniotomy is reportedly being performed safely using remimazolam; however, studies on its efficacy in awake craniotomy have not been conducted. We aimed to compare the efficacy of remimazolam and propofol in awake craniotomy. In this retrospective study, patients who underwent awake craniotomy (n = 36) at our hospital between December 2019 and January 2021 were divided into two groups: the propofol group (P group: n = 21) and the remimazolam group (R group: n = 15). There was no significant difference in the recovery time between the two groups (p = 0.18). The number of patients experiencing nausea was higher in the R group than in the P group (p = 0.02); however, regression analysis revealed that the use of remimazolam contributed to increased intraoperative nausea (odds ratio = 14.4, p = 0.04). No significant differences were observed in the frequency of vomiting and other intraoperative complications between the two groups. In conclusion, remimazolam has the potential for use as an alternative drug in anesthetic management during awake craniotomy.