Optimizing pediatric anesthesia for adenoidectomy procedures

Summaries 1 min 737

Font Size

Created On: 23/01/2026

Pediatric adenoidectomy requires anesthetic strategies that facilitate rapid recovery while minimizing postoperative pain, emergence delirium, and behavioral disturbances.

See All

Key take away

Remimazolam with sevoflurane in combination enhances anesthesia quality and recovery outcomes in children undergoing adenoidectomy.

Background

Pediatric adenoidectomy requires anesthetic strategies that facilitate rapid recovery while minimizing postoperative pain, emergence delirium, and behavioral disturbances. Although sevoflurane is widely used for pediatric anesthesia because of its rapid onset, it is frequently associated with emergence agitation.

Remimazolam, an ultra-short-acting benzodiazepine with a favorable safety profile and controllable sedation depth, has emerged as a promising adjunct. Researchers evaluated the clinical efficacy, safety, and optimal dosing of remimazolam combined with sevoflurane in children undergoing plasma radiofrequency adenoidectomy.

Method

A total of 256 pediatric patients (American Society of Anesthesiologists [ASA] I–II, ages 3–12 years) planned for elective plasma radiofrequency adenoidectomy were enrolled. Volunteers were randomly allocated into four equal groups (64 per group). The control group (Group A) was given 0.9% normal saline, whereas Groups B, C, and D were given continuous infusions of remimazolam benzenesulfonate at doses of 0.4, 0.6, and 0.8 mg/kg/h, respectively. In all remimazolam groups, anesthesia was induced with 6% sevoflurane and maintained at concentrations of 2–3%.

In this prospective, randomized controlled trial, the primary endpoints included emergence time and post-anesthesia care unit (PACU) duration while the secondary endpoints assessed caregiver satisfaction, adverse events, peak pediatric anesthesia emergence delirium (PAED) scores, and postoperative pain.

Result

Groups B, C, and D experienced considerably longer median awakening times when compared with Group A (P < 0.001). In Groups C and D, PACU stay was found to be shorter as opposed to Group A (P < 0.05). In Groups C and D, the postoperative pain (assessed by Face, Legs, Activity, Cry, and Consolability [FLACC] score) was markedly decreased as opposed to Groups A and B (P < 0.05). Peak PAED scores and negative behavioral changes on postsurgery day 3 were decreased in Groups B, C, and D (P < 0.05). In Groups B, C, and D, caregiver satisfaction was highest (P < 0.001). There were no severe undesirable events.

Conclusion

Dose-optimized remimazolam (0.6 mg/kg/h) combined with sevoflurane offered a balanced pediatric anesthesia strategy, delivering stable sedation, faster recovery, improved postoperative comfort, and excellent safety during adenoidectomy in children.