Background: Remimazolam is an ultra-short-acting benzodiazepine characterized by rapid onset and recovery with minimal accumulation after continuous infusion. This systematic review and meta-analysis aimed to evaluate whether remimazolam use results in better postoperative recovery as compared to inhalational anesthetics. Methods: Databases including MEDLINE, EMBASE, CENTRAL, Web of Science, Google Scholar, and Scopus were searched up to August 2024. Randomized controlled trials (RCTs) in adult patients comparing remimazolam with volatile agents were included. The primary outcome was incidence of postoperative nausea and vomiting (PONV) at 24 h. Secondary outcomes included use of rescue antiemetics and analgesics, pain scores, intraoperative hypotension, and other postoperative recovery parameters. Trial sequential analysis (TSA) was performed to validate the robustness of the primary outcome. Results: Twelve RCTs involving 853 patients were analyzed. Remimazolam significantly reduced the incidence of PONV (relative risk [RR] 0.51; 95% confidence interval [CI] 0.27–0.96; I² = 43%; P = 0.04) and need for rescue antiemetics (RR 0.30; 95% CI 0.10–0.89; I² = 0%; P = 0.03) compared to inhalational agents. No significant differences were found in postoperative pain scores (standardized mean difference –0.17; P = 0.11) or analgesic requirement (RR 0.95; P = 0.82). Remimazolam was associated with a significantly lower incidence of intraoperative hypotension (RR 0.58; P = 0.01). Time to extubation, sedation scores, and post-anesthesia care unit stay were comparable. TSA confirmed that the required information size for the primary outcome was reached, indicating statistical conclusiveness. Conclusions Remimazolam use is associated with significantly reduced PONV, rescue antiemetic use, and intraoperative hypotension compared to inhalational agents. TSA confirms the robustness of these findings.

Background: Nasotracheal intubation (NTI) is commonly performed in oromaxillofacial surgeries. We did this metanalysis to ascertain whether use of video laryngoscopy (VL) provided better NTI characteristics as compared to direct laryngoscopy (DL) in patients undergoing oromaxillofacial surgeries. Methods: We performed a systematic search to identify randomized controlled trials comparing VL with DL for NTI in adults undergoing elective oromaxillofacial surgery. The primary outcome was time to intubation. Secondary outcomes included the first attempt success, overall success, incidence of nasal bleeding, Cormack and Lehane grade, and maneuvers required. Results: Of the 456 studies identified following a systematic search, 10 were included. Meta-analysis showed a significantly lower time to tracheal intubation favoring VL (mean difference: –9.04, 95% CI [–12.71, –5.36], P < 0.001; I2 = 59%). VL was also associated with a greater first attempt success (relative risk [RR]: 1.10, 95% CI [1.04, 1.16], P = 0.001). Maneuvers to facilitate intubation were less with VL (RR: 0.22, 95% CI [0.10, 0.51], P < 0.001). There was no difference in overall intubation success (RR: 1.04, 95% CI [0.98, 1.10], P = 0.17). The incidence of bleeding did not differ between the DL and VL groups (RR: 0.59, 95% CI [0.32, 1.08], P = 0.09). Conclusions Evidence as per this meta-analysis suggests VL leads to a shorter time to NTI, a greater first attempt success rate, and reduced need for maneuvers when compared to DL. The present study supports use of VL as a first line device for NTI in oral-maxillofacial surgeries in experienced hands.

Background: Nasotracheal intubation (NTI) is commonly performed in oromaxillofacial surgeries. We did this metanalysis to ascertain whether use of video laryngoscopy (VL) provided better NTI characteristics as compared to direct laryngoscopy (DL) in patients undergoing oromaxillofacial surgeries. Methods: We performed a systematic search to identify randomized controlled trials comparing VL with DL for NTI in adults undergoing elective oromaxillofacial surgery. The primary outcome was time to intubation. Secondary outcomes included the first attempt success, overall success, incidence of nasal bleeding, Cormack and Lehane grade, and maneuvers required. Results: Of the 456 studies identified following a systematic search, 10 were included. Meta-analysis showed a significantly lower time to tracheal intubation favoring VL (mean difference: –9.04, 95% CI [–12.71, –5.36], P < 0.001; I2 = 59%). VL was also associated with a greater first attempt success (relative risk [RR]: 1.10, 95% CI [1.04, 1.16], P = 0.001). Maneuvers to facilitate intubation were less with VL (RR: 0.22, 95% CI [0.10, 0.51], P < 0.001). There was no difference in overall intubation success (RR: 1.04, 95% CI [0.98, 1.10], P = 0.17). The incidence of bleeding did not differ between the DL and VL groups (RR: 0.59, 95% CI [0.32, 1.08], P = 0.09). Conclusions Evidence as per this meta-analysis suggests VL leads to a shorter time to NTI, a greater first attempt success rate, and reduced need for maneuvers when compared to DL. The present study supports use of VL as a first line device for NTI in oral-maxillofacial surgeries in experienced hands.