Comparison of Remimazolam-Based Monitored Anesthesia Care and Inhalation-Based General Anesthesia in Transurethral Resection of Bladder Tumor: A Randomized-Controlled Trial

Abstract

Background/objectives: Transurethral resection of bladder tumor (TURBT) is commonly performed in elderly patients and often requires repeated procedures. A high proportion of non-procedural time in TURBT affects operating room utilization, highlighting the need for a safe and efficient anesthesia method. This study aimed to compare remimazolam-based monitored anesthesia care (MAC) guided by analgesia nociception index (ANI) monitoring to inhalation-based general anesthesia (GA) for TURBT, focusing on induction and emergence time (IAET).

Methods: Forty-six patients who underwent TURBT were randomly assigned into either the MAC group or GA group. The primary outcome was the IAET. The secondary outcomes included hospital and anesthesia charges, safety (intraoperative hypotension and desaturation), and feasibility (surgeon and patient satisfaction) of both anesthetic methods.

Results: The MAC group demonstrated a significantly shorter IAET (14 vs. 25 min, p < 0.001) and lower anesthesia cost (USD 152 vs. USD 195, p < 0.001). The MAC group showed better hemodynamic stability with a lower incidence of hypotension (29% vs. 73%, p = 0.004). Seven patients (33%) in the MAC group experienced intraoperative desaturation; all patients recovered without complications through the jaw-thrust maneuver. Patient satisfaction was equally high in both groups, and surgeon satisfaction, though slightly lower with MAC (71% vs. 100% rating "excellent", p = 0.009), remained acceptable.

Conclusions: Remimazolam-based MAC, guided by ANI monitoring, offers significant advantages including shorter IAET, reduced costs, and improved safety for TURBT, particularly in patients with small tumors. These findings support MAC as a promising alternative to GA for TURBT, as it enhances perioperative outcomes and operating room efficiency.