Rapidly Reversible Monitored Anesthesia Care with Remimazolam and Flumazenil Reversal for Transcatheter Aortic Valve Replacement: A Randomized Controlled Trial

Background/Objectives: Monitored anesthesia care (MAC) is increasingly used for transcatheter aortic valve replacement (TAVR), where rapid recovery of consciousness may facilitate early postoperative neurological assessment. Remimazolam provides sedation that can be pharmacologically reversed with flumazenil. We compared emergence from sedation between a remimazolam–flumazenil-based MAC strategy and a conventional dexmedetomidine-based strategy in patients undergoing transfemoral TAVR.

Methods

In this single-center randomized controlled trial, 84 patients undergoing transfemoral TAVR were randomized 1:1 to remimazolam–remifentanil (R group) or dexmedetomidine–propofol–remifentanil (D group) MAC. Flumazenil was administered at the initiation of the postoperative awakening attempt in the R group. The primary outcome was arousal time, assessed using two prespecified measures: time from discontinuation of all anesthetic infusions to arousal and time from initiation of the postoperative awakening attempt to arousal. Arousal was defined as a Modified Observer’s Assessment of Alertness/Sedation score of 5.